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:

  1. 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).
  2. 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.
  3. The discovery of AF on monitoring in patients with a prior stroke is associated with a subsequent prescription for oral anticoagulation.
  4. 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.
  5. Detection of subclinical AF during interrogation of CIEDs is common.
  6. 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.
  7. In patients with CIEDs who have experienced a recent thromboembolic event, device interrogation frequently fails to reveal a recent episode of AF.
  8. In patients with device-detected AF and risk factors for stroke, oral anticoagulation is prescribed in only a minority of patients.
  9. 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.
  10. 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.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Atrial Fibrillation, Defibrillators, Implantable, Electrocardiography, Ambulatory, Risk Factors, Stroke

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