Relationship between device-detected burden and duration of atrial fibrillation and risk of ischemic stroke

Al-Gibbawi, Mounir; Ayinde, Hakeem; El‐Chami, Mikhael F.; Westerman, Stacy; León, Angel R.; Patel, Ankit; Lurgio, David B. De; Tompkins, Christine; Lloyd, Michael S.; Merchant, Faisal M.; Kiani, Soroosh

doi:10.1016/j.hrthm.2020.10.017

Cited by 21 publications

(16 citation statements)

References 19 publications

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“… 31 More detailed analysis of AF burden dynamics and temporal distribution of AF episodes can be performed, such as analysis of AF density 32 that could provide a more granular characterization of AF, with potentially novel implications for assessing the relationship with stroke risk and atrial remodelling. In studies on CIEDs, both the burden of AF and the duration of AF episodes have been assessed and the two variables appear correlated to each other, although a direct association with stroke/TIA is not validated 33 unless variable combinations with CHADS 2 or CHA 2 DS 2 -VASc are taken into consideration. 21 Notably, these risk stratification scores were first proposed in the setting of clinical AF, and the reported incidence rates of stroke events were lower for AHRE compared with clinical AF, although with an increased risk of stroke associated with increasing stroke risk factors.…”

Section: Arrhythmia Burden: Dynamic Relationships Arrhythmia Progression and Clinical Implications For Stroke Riskmentioning

confidence: 99%

Optimizing indices of atrial fibrillation susceptibility and burden to evaluate atrial fibrillation severity, risk and outcomes

Boriani

Vitolo

Diemberger

et al. 2021

Cardiovascular Research

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Atrial fibrillation (AF) has heterogeneous patterns of presentation concerning symptoms, duration of episodes, AF burden, and the tendency to progress towards the terminal step of permanent AF. AF is associated with a risk of stroke/thromboembolism traditionally considered dependent on patient-level risk factors rather than AF type, AF burden or other characterizations. However, the time spent in AF appears related to an incremental risk of stroke, as suggested by the higher risk of stroke in patients with clinical AF versus subclinical episodes and in patients with non-paroxysmal AF versus paroxysmal AF. In patients with device-detected atrial tachyarrhythmias, AF burden is a dynamic process with potential transitions from a lower to a higher maximum daily arrhythmia burden, thus justifying monitoring its temporal evolution. In clinical terms, the appearance of the first episode of AF, the characterization of the arrhythmia in a specific AF type, the progression of AF, and the response to rhythm control therapies, as well as the clinical outcomes, are all conditioned by underlying heart disease, risk factors, and comorbidities. Improved understanding is needed on how to monitor and modulate the effect of factors that condition AF susceptibility and modulate AF-associated outcomes. The increasing use of wearables and apps in practice and clinical research may be useful to predict and quantify AF burden and assess AF susceptibility at the individual patient level. This may help us reveal why AF stops and starts again, or why AF episodes, or burden, cluster. Additionally, whether the distribution of burden is associated with variations in the propensity to thrombosis or other clinical adverse events. Combining the improved methods for data analysis, clinical and translational science could be the basis for the early identification of the subset of patients at risk of progressing to a longer duration/higher burden of AF and the associated adverse outcomes.

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Section: Arrhythmia Burden: Dynamic Relationships Arrhythmia Progression and Clinical Implications For Stroke Riskmentioning

confidence: 99%

Optimizing indices of atrial fibrillation susceptibility and burden to evaluate atrial fibrillation severity, risk and outcomes

Boriani

Vitolo

Diemberger

et al. 2021

Cardiovascular Research

View full text Add to dashboard Cite

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“…A large VA cohort showed the greatest benefit of anticoagulation was for AF episodes more than 24 h 4 . Our group has shown that incidental detection of atrial fibrillation by implantable devices varies widely over time, so that even 30 s of atrial fibrillation (below the threshold of all currently available implantable monitors including the one studied here) may portend 2 h of atrial fibrillation in the future 5 . The data thus far signal that a “dose–response” effect of AF/AT does probably exist.…”

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confidence: 77%

Enhanced detection of atrial arrhythmias by implantable monitors: Have we found what we are looking for?

Lloyd

2021

Cardiovasc electrophysiol

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“…A recent KP-Rhythm study identified a higher risk of stroke in the high-load group (> 11%, approximately 2.5 h/24 h) [ 23 ]. A study including 384 patients with cardiovascular implantable electronic device-detected AF not receiving oral anticoagulation suggested that the duration of AF was not associated with the risk of stroke, whereas the CHA 2 DS 2 -VASc score was [ 24 ]. There is no standardized AF burden threshold to predict a significantly increased risk of thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Relationship among atrial fibrillation, the CHA2DS2-VASc score and ischaemic stroke in patients with coronary artery disease: a propensity score matching study in Hebei, China

Shi

Liu

Wang

et al. 2021

BMC Cardiovasc Disord

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Background Recent evidence has shown that the pathogenesis of ischaemic stroke associated with atrial fibrillation (AF) is complex and involves other factors in addition to arrhythmias. The purpose of this study was to investigate the relationship among AF, CHA2DS2-VASc score and ischaemic stroke in patients with coronary artery disease (CAD) in Hebei, China. Methods A total of 2,335 patients with CAD from September 2016 to May 2019 at the Second Hospital of Hebei Medical University were included (mean age 62.73 ± 10.35 years, range 26–92 years; 41.58% female). This was a cross-sectional study, and participants were divided into non-stroke (n = 1997) and ischaemic stroke groups (n = 338). Propensity score matching (PSM) was performed to match ischaemic stroke patients with non-stroke patients in a 1:4 ratio. The relationship among AF, the CHA2DS2-VASc score and ischaemic stroke was evaluated using univariable generalized linear models for different sex, age, body mass index (BMI), CAD and CHA2DS2-VASc score subgroups. Univariable and multivariable generalized linear models were used to evaluate the relationship between AF and ischaemic stroke in the different models. Results Compared with that in the non-stroke group, the prevalence of AF (8.81% vs. 14.20%, P = 0.002) in the ischaemic stroke group was higher. The proportion of patients with ischaemic stroke was significantly different between the AF group and the non-AF group (28.74% vs. 19.04%, P = 0.003). An increasing CHA2DS2-VASc score was associated with a gradual increase in the prevalence of AF (P for trend < 0.001). Subgroup analysis showed that the trend towards increased stroke risk in the AF group was consistent across the various subgroups. The multivariable analysis demonstrated that AF was not associated with ischaemic stroke compared with the absence of AF (OR = 1.55, 95% CI 0.94–2.56, P = 0.087). Conclusion In our cross-sectional study, after adjustment for confounding factors, there was no association between AF and ischaemic stroke. The increased risk of ischaemic stroke associated with AF was attenuated by atherosclerotic factors. Our study supports the current view that enhanced control of modifiable cardiovascular risk factors in patients with AF is essential.

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Relationship between device-detected burden and duration of atrial fibrillation and risk of ischemic stroke

Cited by 21 publications

References 19 publications

Optimizing indices of atrial fibrillation susceptibility and burden to evaluate atrial fibrillation severity, risk and outcomes

Optimizing indices of atrial fibrillation susceptibility and burden to evaluate atrial fibrillation severity, risk and outcomes

Enhanced detection of atrial arrhythmias by implantable monitors: Have we found what we are looking for?

Relationship among atrial fibrillation, the CHA2DS2-VASc score and ischaemic stroke in patients with coronary artery disease: a propensity score matching study in Hebei, China

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