Subclinical Atrial Fibrillation and the Risk of Recurrent Ischemic Stroke

Wachter, Rolf; Freedman, Ben

doi:10.1055/s-0041-1726403

Cited by 14 publications

(5 citation statements)

References 16 publications

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“…6,7 Indeed, even asymptomatic AF patients are associated with a high risk of stroke and mortality. [21][22][23] Different from these previous studies, the EAST-AFNET 4 trial included AF ablation as a rhythm control therapy. However, there were only 8% and 19.4% of patients received catheter ablations at baseline and 2 years, respectively, in the early rhythm control arm, and around 7% of patients enrolled in the usual care group also received catheter ablations.…”

Section: Discussionmentioning

confidence: 99%

Early Rhythm Control and the Risks of Ischemic Stroke, Heart Failure, Mortality, and Adverse Events When Performed Early (<3 Months): A Nationwide Cohort Study of Newly Diagnosed Patients with Atrial Fibrillation

et al. 2022

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Background: In EAST-AFNET 4 trial, early rhythm control was associated with better clinical outcomes for patients with atrial fibrillation (AF). However, whether the better outcomes of patients assigned to rhythm control were solely due to “early” intervention or because of more regular and structured follow up was unclear. Objective: To investigate whether the findings of EAST trial are applicable to the ‘real world’ clinical setting, where a less structured management protocol is operated. Methods: From 2001 to 2016, 301,064 newly-diagnosed AF patients were identified from Taiwan National Health Insurance Research Database. Among these patients, 62,649 AF patients receiving antiarrhythmic drugs or catheter ablation within 1 year after AF being diagnosed were categorized as the early rhythm control group, and the remaining 238,415 patients were defined as usual care group. Risk of clinical events were compared. Results: Compared to usual care, early rhythm control was associated with a lower adjusted risk of ischemic stroke(aHR 0.771; p<0.001), heart failure(aHR 0.851; p<0.001), acute myocardial infarction(aHR 0.915; p<0.001), mortality(aHR 0.794; p<0.001) and composite adverse events(aHR 0.823; p<0.001). Compared to usual care, the lower risks of ischemic stroke(aHR 0.746), heart failure(aHR 0.819), mortality(aHR 0.777) and composite adverse events(aHR 0.802) associated with early rhythm control were even more evident when performed early (<3months)(pint<0.001). Principal results were generally consistent for majority of subgroups studied and among the cohort after propensity matching. Conclusions: Early rhythm control, especially when performed earlier (<3months), was associated with a lower risk of adverse events than usual care among patients with early AF.

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Section: Discussionmentioning

confidence: 99%

Early Rhythm Control and the Risks of Ischemic Stroke, Heart Failure, Mortality, and Adverse Events When Performed Early (<3 Months): A Nationwide Cohort Study of Newly Diagnosed Patients with Atrial Fibrillation

et al. 2022

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“…The overall recurrent event rate of 18% in our study is similar to Kitsiou et al 15 and is usually higher in CS/ESUS patients like ours than non-CS patients and massively elevated compared to patients without stroke (e.g., cardiovascular risk factors only). 16 The absence of a difference in recurrent cerebrovascular event rate in AF versus no-AF patients may be explained by the early initiation of anticoagulation following AF detection. Moreover, our finding of ischemic strokes within 30 days of AF detection predominantly in not adequately anticoagulated patients promotes the immediate initiation of anticoagulation once AF is detected.…”

Section: Discussionmentioning

confidence: 99%

Age-Dependent Detection of Atrial Fibrillation with Implantable Cardiac Monitors in Patients with Cryptogenic Stroke

Uhe,

Keilitz,

Berrouschot

et al. 2024

TH Open

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Background Continuous monitoring using implantable cardiac monitors (ICMs) results in atrial fibrillation (AF) detection rates of up to 30% in patients with cryptogenic stroke (CS). Although higher age is an independent risk factor for AF, there are no age-specific recommendations for the implantation of ICM. Objective The aim of this study was to analyze age-related AF rates in patients with CS and continuous rhythm monitoring, to determine the rates of oral anticoagulation (OAC) and recurrent cerebrovascular events (stroke or transient ischemic attack) in patients with ICM-detected AF, and to describe the temporal relationship of AF detection and recurrent cerebrovascular events. Methods In this observational study, patients with CS provided with ICMs were systematically followed. All patients underwent 72-hour electrocardiography monitoring, transcranial Doppler ultrasound, and transthoracic echocardiography prior to ICM insertion. Follow-up included a regular outpatient presentation every 3 months with medical history, physical examination, and interrogation of the ICM. Results One-hundred eighty-six patients (mean age: 65 ± 12 years, 54% female) were included in this analysis. AF was detected in 6, 27, 56, and 65% (p < 0.001) of patients aged less than 60, 60 to 69, 70 to 79, and more than or equal to 80 years, respectively. All patients with AF under 60 years had an impaired left ventricular systolic function. OAC was initiated in 85% of the patients with AF. Recurrent cerebrovascular events occurred in 34 patients of whom 14 had a diagnosis of AF. In nine patients, AF was diagnosed before the occurrence of a recurrent cerebrovascular event. Conclusion AF prevalence increased with age and was absent in CS patients younger than 60 years and with preserved left ventricular ejection fraction. The temporal relationship of AF and recurrent cerebrovascular events was weak.

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“…This appears important in interpreting our main findings because clinical decision making, according to guideline recommendations [1,33,34], is based on clinical considerations that include age and the other components of the CHA 2 DS 2 VASc score. This has important implications given the increasing detection of (often asymptomatic) AF with cardiac devices [9,[35][36][37].…”

Section: Importance Of Integrated Approach To Af Carementioning

confidence: 99%

Comparing Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation: A Systematic Review and Meta-Analysis of 81,462 Patients

Sgreccia

Manicardi

Malavasi

et al. 2021

JCM

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Background: In atrial fibrillation (AF) patients, the presence of symptoms can guide the decision between rate or rhythm control therapy, but it is still unclear if AF-related outcomes are determined by symptomatic status of their clinical presentation. Methods: We performed a systematic review and metanalysis following the PRISMA recommendations on available studies that compared asymptomatic to symptomatic AF reporting data on all-cause mortality, cardiovascular death, and thromboembolic events (TEs). We included studies with a total number of patients enrolled equal to or greater than 200, with a minimum follow-up period of six months. Results: From the initial 5476 results retrieved after duplicates’ removal, a total of 10 studies were selected. Overall, 81,462 patients were included, of which 21,007 (26%) were asymptomatic, while 60,455 (74%) were symptomatic. No differences were found between symptomatic and asymptomatic patients regarding the risks of all-cause death (odds ratio (OR) 1.03, 95% confidence interval (CI) 0.81–1.32), and cardiovascular death (OR 0.87, 95% CI 0.54–1.39). No differences between symptomatic and asymptomatic groups were evident for stroke (OR 1.22, 95% CI 0.77–1.93) and stroke/TE (OR 1.06, 95% CI 0.86–1.31) risks. Conclusions: Mortality and stroke/TE events in AF patients were unrelated to symptomatic status of their clinical presentation. Adoption of management strategies in AF patients should not be based on symptomatic clinical status.

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Subclinical Atrial Fibrillation and the Risk of Recurrent Ischemic Stroke

Cited by 14 publications

References 16 publications

Early Rhythm Control and the Risks of Ischemic Stroke, Heart Failure, Mortality, and Adverse Events When Performed Early (<3 Months): A Nationwide Cohort Study of Newly Diagnosed Patients with Atrial Fibrillation

Early Rhythm Control and the Risks of Ischemic Stroke, Heart Failure, Mortality, and Adverse Events When Performed Early (<3 Months): A Nationwide Cohort Study of Newly Diagnosed Patients with Atrial Fibrillation

Age-Dependent Detection of Atrial Fibrillation with Implantable Cardiac Monitors in Patients with Cryptogenic Stroke

Comparing Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation: A Systematic Review and Meta-Analysis of 81,462 Patients

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