Role of insertable cardiac monitors in anticoagulation therapy in patients with atrial fibrillation at high risk of bleeding

Mascarenhas, Daniel; Farooq, Mohammad Umar; Ziegler, Paul; Kantharia, Bharat K.

doi:10.1093/europace/euv350

Cited by 18 publications

(16 citation statements)

References 20 publications

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“…An option for minimization of anticoagulant risk could be the transient use of oral anticoagulation linked to onset and offset of an episode of AF in patients at high risk of bleeding and low burden of AF. One such study used data from real-world practice setting in patients with AF and ICM devices [ 57 ]. Up to 87% of patients had a low AF burden, classified as presence of AF in <1% of the time and were therefore eligible to discontinue anticoagulation.…”

Section: Targeted Anticoagulation In Patients At High Risk Of Bleedinmentioning

confidence: 99%

How and When to Screen for Atrial Fibrillation after Stroke: Insights from Insertable Cardiac Monitoring Devices

Bridge

Thijs

2016

J Stroke

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The introduction of insertable cardiac monitoring devices has dramatically altered our understanding of the role of intermittent atrial fibrillation in cryptogenic stroke. In this narrative review we discuss the incidence, timing and relationship between atrial fibrillation and cryptogenic stroke, how to select patients for monitoring and the value and limitations of different monitoring strategies. We also discuss the role of empirical anticoagulation, and atrial fibrillation burden as a means of tailoring anticoagulation in patients at high risk of bleeding.

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Section: Targeted Anticoagulation In Patients At High Risk Of Bleedinmentioning

confidence: 99%

How and When to Screen for Atrial Fibrillation after Stroke: Insights from Insertable Cardiac Monitoring Devices

Bridge

Thijs

2016

J Stroke

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“…Without an objective and continuous monitoring of cardiac rhythm by implantable devices, it is not easy to accurately determine the efficacy and adverse effects of AAD. Short-term rhythm monitoring with event monitor or Holter monitor for a period ranging from 1 week to 1 month may miss brief intermittent periods of AF or other arrhythmias [ 19 ]. Thus, continuous rhythm monitoring to detect episodes of AF recurrence and proarrhythmias/bradycardia potentially related to AAD was another important aspect of our study.…”

Section: Discussionmentioning

confidence: 99%

Revisiting the Role of Antiarrhythmic Drugs in Prevention of Atrial Fibrillation Recurrence: A Single Center Retrospective Review

Mascarenhas

Sharma

2018

Cardiol Res

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BackgroundWe conducted a retrospective analysis to revisit the efficacy of four different commonly used antiarrhythmic drugs (AADs) in a single community hospital setting in the U.S. We used cardiac implantable electronic devices (CIEDs) to continuously monitor the patients for maintenance of sinus rhythm. The CIEDs in our study included insertable cardiac monitor (ICM), permanent pacemaker (PPM) and cardiac resynchronization therapy-defibrillator (CRT-D). The aim was to compare efficacy of commonly used AADs for maintenance of sinus rhythm in atrial fibrillation (AF) patients.MethodsWe conducted our retrospective study in a real world practice setting. We analyzed electronic medical records of 145 consecutive patients with paroxysmal and persistent AF who were treated with AADs for maintenance of sinus rhythm between the period of April 2014 and February 2018.ResultsTotal 34 out of 145 patients (23.45%) had AF recurrence. The mean duration of first AF recurrence in total patient cohort was 18.01 ± 12 months. There was no major difference in efficacy in terms of prevention of first episode of AF recurrence among commonly used class III and class IC AADs.ConclusionsHigher doses clearly seem to be more effective in preventing the recurrence of AF in class III AADs; sotalol and amiodarone. Use of CIEDs helps to continuously monitor patients for recurrence of AF and detects proarrhythmic effects of AADs.

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“…Following ablation, the maximum daily burden was significantly reduced and the majority of patients had a maximum AF burden of <5 min/day. While medication was not collected consistently within this trial, recent studies have identified that utilizing continuous AF monitoring could be effective in management of antiarrhythmic and anticoagulation therapies for a selected group of patients …”

Section: Discussionmentioning

confidence: 99%

Continuous Cardiac Monitoring around Atrial Fibrillation Ablation: Insights on Clinical Classifications and End Points

Dekker

Pokushalov

Sanders

et al. 2016

Pacing Clinical Electrophis

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Role of insertable cardiac monitors in anticoagulation therapy in patients with atrial fibrillation at high risk of bleeding

Abstract: In AF patients with high bleeding risk, ICM-guided rhythm control with AADs and assessment of AF burden may allow safe discontinuation of OACs.

Cited by 18 publications

References 20 publications

How and When to Screen for Atrial Fibrillation after Stroke: Insights from Insertable Cardiac Monitoring Devices

How and When to Screen for Atrial Fibrillation after Stroke: Insights from Insertable Cardiac Monitoring Devices

Revisiting the Role of Antiarrhythmic Drugs in Prevention of Atrial Fibrillation Recurrence: A Single Center Retrospective Review

Continuous Cardiac Monitoring around Atrial Fibrillation Ablation: Insights on Clinical Classifications and End Points

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