Device-Detected Atrial Fibrillation: What to Do With Asymptomatic Patients? | Journal Scan
- Chen-Scarabelli C, Scarabelli TM, Ellenbogen KA, Halperin JL.
- J Am Coll Cardiol 2015;65:281-294.
The following are 10 points to remember about what to do with device-detected atrial fibrillation (AF) in asymptomatic patients:
- In patients with cryptogenic stroke, the yield of AF is much higher with the use of an implantable loop recorder versus conventional monitoring (electrocardiography [ECG] or ambulatory monitoring).
- Similarly, in patients who have suffered a stroke, the rate of AF detection is higher with an event monitor for 30 days than with a 24-hour Holter monitor.
- The discovery of AF on monitoring in patients with a prior stroke is associated with a subsequent prescription for oral anticoagulation.
- Cardiac implantable electronic devices (CIEDs), specifically dual-chamber pacemakers and defibrillators, are capable of continuous monitoring, and therefore, constitute the gold standard for arrhythmia detection.
- Detection of subclinical AF during interrogation of CIEDs is common.
- Device detection of “atrial high rate events,” or atrial tachycardia, or “mode-switch” episodes requires confirmation by direct electrogram analysis lest external noise, lead fracture, and other phenomena are erroneously diagnosed as “AF,” which has significant implications.
- In patients with CIEDs who have experienced a recent thromboembolic event, device interrogation frequently fails to reveal a recent episode of AF.
- In patients with device-detected AF and risk factors for stroke, oral anticoagulation is prescribed in only a minority of patients.
- The reasons for withholding oral anticoagulation in patients with device-detected AF, as compared to conventionally diagnosed AF, are not clear, but may have to do with lack of familiarity with interpretation of stored electrograms.
- Although definitive data are lacking regarding management of patients with device-detected AF, it is reasonable to treat these patients with oral anticoagulation, as per the current risk stratification schemes.
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