Temporal relationship of atrial tachyarrhythmias, cerebrovascular events, and systemic emboli based on stored device data: A subgroup analysis of TRENDS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Ryzyko udaru u pacjentów z AHRE wydaje się mniejsze niż u pacjentów z rozpoznaniem AF i nie wszystkie epizody AHRE oznaczają AF [142]. Udary mózgu często występują również u pacjentów, u których nie stwierdza się AHRE w ciągu 30 dni poprzedzających wystąpienie udaru [143][144][145][146][147]. W rezultacie nie jest jasne, czy AHRE wiążą się z tymi samymi wymogami terapeutycznymi, co jawne AF [148], a korzyści z OAC u pacjentów z AHRE są oceniane w trwających próbach klinicznych, np.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…And finally, the writing group recommends that for patients in whom discontinuation of anticoagulation is being considered based on the patient’s values and preferences, they should consider undergoing continuous or frequent ECG monitoring to screen for AF recurrence (Class IIb, LOE C-EO, Table 4). This recommendation is based on the following: (1) recurrences of AF are common both early and late following AF ablation; (2) asymptomatic AF is common, and is more common following AF ablation than prior to AF ablation; (3) AF ablation destroys a portion of the atria and the impact of this on stroke risk is uncertain; (4) there have been no large, randomized prospective trials that have assessed the safety of discontinuing anticoagulation in this patient population; (5) studies have shown that strokes in patients with AF might not be temporaneously related to an AF event 855 ; and (6) the use of direct thrombin inhibitors or Factor Xa inhibitors, such as dabigatran, rivaroxaban, edoxaban and apixaban, is more convenient than warfarin. 825,826,827,828 …”

Cardiac Arrhythmia following Stroke

“…Much more frequently, the episodes occurred more than 30 days earlier, or occurred for the first time after a stroke [32]. Two further studies with similar methodologies also concluded that the majority of cardiac embolisms occur without immediately preceding episodes of atrial fibrillation [33,34]. Modern concepts are therefore based on the assumption that episodes of atrial fibrillation are only "the tip of the iceberg" and the epiphenomena of a complex disease of the atria, with risk of stroke persisting even after conversion to sinus rhythm [35,36].…”

“…This approach appears to be intuitively correct but fails to convince as far an understanding of the large number of atrial fibrillation-associated stroke events is concerned. Most recently, newer data have raised serious questions about this approach [32][33][34]: In the AS-SERT study, involving 2 580 patients with implanted cardiac pacemaker or AICD aggregate groups, a total of 51 patients during follow-up of 2.5 years suffered an ischemic stroke or a systemic embolism. A reading of the pacemaker memory allowed to study the temporal relationship between atrial fibrillation episodes and the occurrence of stroke: In a period of 30 days before the occurrence of stroke, atrial fibrillation episodes > 6 min were detectable in only n 8 % of the cases.…”