The epidemiology and mortality of patients with atrial fibrillation: a complex landscape

Introduction Nowadays, no clear predictors of atrial fibrillation in patients with embolic stroke of undetermined source (ESUS) are known. Some echocardiographic parameters have been proposed as potential predictors of atrial fibrillation in patients with ESUS. The ratio between left atrial volume and tissue Doppler (TDI) a’ provides the left atrial volumetric/mechanical coupling index (LACI) and represents a feasible surrogate for left atrial function, and might be useful to identify atrial fibrillation in this subset of patients. Methods and results All consecutive patients having undergone an implantable loop recorder (ILR) for ESUS between 2017 and 2022 were retrospectively enrolled. All patients were followed through remote monitoring and telephone visit for a minimum follow-up of 6 months. A total number of 129 patients (mean age: 72.2 ± 8.8 years; 55% of men) were analyzed. Patients developing atrial fibrillation presented higher baseline LACI (5.53 ± 2.52 vs. 3.25 ± 1.19, P < 0.001). The multivariate analysis showed that LACI was independently and significantly associated with atrial fibrillation (hazard ratio = 1.21, 95% confidence interval 1.09–1.32, P < 0.01). The best cut-off value of LACI was found to be 4.24. Discussion Our data confirm that LACI is independently associated with atrial fibrillation in patients with ILR following ESUS, accounting for clinical or echocardiographic factors.

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Atrial High-Rate Episodes and Subclinical Atrial Fibrillation: State of the Art and Clinical Questions with Complex Solutions

Griffith Brookles,

De Ponti,

Russo

et al. 2024

Rev. Cardiovasc. Med.

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Atrial high-rate episodes (AHREs) and subclinical atrial fibrillation (AF) are frequently registered in asymptomatic patients with cardiac implantable electronic devices (CIEDs) and insertable cardiac monitors (ICMs). While an increased risk of thromboembolic events (e.g., stroke) and benefits from anticoagulation have been widely assessed in the setting of clinical AF, concerns persist about optimal clinical management of subclinical AF/AHREs. As a matter of fact, an optimal threshold of subclinical episodes’ duration to predict stroke risk is still lacking and recently published randomized clinical trials assessing the impact of anticoagulation on thromboembolic events in this specific setting have shown contrasting results. The aim of this review is to summarize current evidence regarding classification and clinical impact of subclinical AF/AHREs and to discuss the latest evidence regarding the potential benefit of anticoagulation in this setting, highlighting which clinical questions are still unanswered.

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The epidemiology and mortality of patients with atrial fibrillation: a complex landscape

Cited by 3 publications

References 59 publications

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Left atrial volumetric/mechanical coupling index and atrial fibrillation in the embolic stroke of undetermined source

Atrial High-Rate Episodes and Subclinical Atrial Fibrillation: State of the Art and Clinical Questions with Complex Solutions

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