Adverse prognosis of incidentally detected ambulatory atrial fibrillation

Martínez, Carlos; Katholing, Anja; Freedman, Ben

doi:10.1160/th4-04-0383

Cited by 128 publications

(99 citation statements)

References 43 publications

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“…5 Most of the study monitor-detected AF was brief and subclinical, and may or may not have been causally related to the index stroke, but nevertheless represents a potentially treatable risk factor for recurrent stroke. 7,24,31,32 Increasing age is known to be associated with a greater likelihood of both clinical and subclinical AF, 4,33 but we found that age was not a significant predictor when APB count is included in the model. However, we did not study patients aged <55 years so the ability to fully assess the effect of age was limited.…”

Section: Gladstone Et Al Predicting Af In Cryptogenic Stroke 939contrasting

confidence: 55%

Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke

Gladstone

Dorian

Spring

et al. 2015

Stroke

170

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Background and Purpose— Many ischemic strokes or transient ischemic attacks are labeled cryptogenic but may have undetected atrial fibrillation (AF). We sought to identify those most likely to have subclinical AF. Methods— We prospectively studied patients with cryptogenic stroke or transient ischemic attack aged ≥55 years in sinus rhythm, without known AF, enrolled in the intervention arm of the 30 Day Event Monitoring Belt for Recording Atrial Fibrillation After a Cerebral Ischemic Event (EMBRACE) trial. Participants underwent baseline 24-hour Holter ECG poststroke; if AF was not detected, they were randomly assigned to 30-day ECG monitoring with an AF auto-detect external loop recorder. Multivariable logistic regression assessed the association between baseline variables (Holter-detected atrial premature beats [APBs], runs of atrial tachycardia, age, and left atrial enlargement) and subsequent AF detection. Results— Among 237 participants, the median baseline Holter APB count/24 h was 629 (interquartile range, 142–1973) among those who subsequently had AF detected versus 45 (interquartile range, 14–250) in those without AF ( P <0.001). APB count was the only significant predictor of AF detection by 30-day ECG ( P <0.0001), and at 90 days ( P =0.0017) and 2 years ( P =0.0027). Compared with the 16% overall 90-day AF detection rate, the probability of AF increased from <9% among patients with <100 APBs/24 h to 9% to 24% in those with 100 to 499 APBs/24 h, 25% to 37% with 500 to 999 APBs/24 h, 37% to 40% with 1000 to 1499 APBs/24 h, and 40% beyond 1500 APBs/24 h. Conclusions— Among older cryptogenic stroke or transient ischemic attack patients, the number of APBs on a routine 24-hour Holter ECG was a strong dose-dependent independent predictor of prevalent subclinical AF. Those with frequent APBs have a high probability of AF and represent ideal candidates for prolonged ECG monitoring for AF detection. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00846924.

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Section: Gladstone Et Al Predicting Af In Cryptogenic Stroke 939contrasting

confidence: 55%

Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke

Gladstone

Dorian

Spring

et al. 2015

Stroke

170

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“…50 However, the relationship between AF burden and stroke risk is not fully established. In 28.6% of individuals with AF detected by intermittent ECGs, the diagnosis was made from 1 episode of AF, and 12 individuals presented with ≥2 episodes of AF <30 seconds, likely representing a low AF burden.…”

Section: Limitationsmentioning

confidence: 99%

Mass Screening for Untreated Atrial Fibrillation

et al. 2015

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Background-The aims of the present study were to define the prevalence of untreated atrial fibrillation (AF) in a systematic screening program using intermittent ECG recordings among 75-to 76-year-old individuals and to study the feasibility of initiating protective oral anticoagulant (OAC) treatment. Methods and Results-Half of the 75-to 76-year-old population in 2 Swedish regions were invited to a screening program for AF. Participants without a previous diagnosis of AF underwent intermittent ECG recordings over 2 weeks. If AF was detected, participants were offered OAC. During the 28-month inclusion period, 13 331 inhabitants were invited. Of these, 7173 (53.8%) participated. Of the participants, 218 (3.0%; 95% confidence interval [CI], 2.7-3.5) were found to have previously unknown AF, and of these, AF was found in 37 (0.5% of the screened population) on their first ECG. The use of intermittent ECGs increased new AF detection 4-fold. A previous diagnosis of AF was known in 9.3% (n=666; 95% CI, 8.6-10.0). Total AF prevalence in the screened population was 12.3%. Of participants with known AF, 149 (2.1%; 95% CI, 1.8-2.4) had no OAC treatment. In total, 5.1% (95% CI, 4.6-5.7) of the screened population had untreated AF; screening resulted in initiation of OAC treatment in 3.7% (95% CI, 3.3-4.2) of the screened population. More than 90% of the participants with previously undiagnosed AF accepted initiation of OAC treatment. Conclusions-Mass

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“…AF oft en is asymptomatic, and only one in 12 paroxysms of AF are symptomatic. 32 Indeed, asymptomatic AF may carry a poor prognosis, 33 and symptoms are not a good guide to whether AF is present. 34 Associated comorbidities such as hypertension and heart failure need to be managed as part of a holistic approach to AF management.…”

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confidence: 99%