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1.
J Am Coll Cardiol ; 74(22): 2782-2785, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31779792
2.
Circulation ; 140(22): 1834-1850, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31765261

RESUMO

Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring followed by oral anticoagulation (OAC) treatment have been proposed to prevent recurrent cardioembolic strokes. This white paper by experts from the AF-SCREEN International Collaboration summarizes existing evidence and knowledge gaps on searching for AF after a stroke by using ECG monitoring. New AF can be detected by routine plus intensive ECG monitoring in approximately one-quarter of patients with ischemic stroke. It may be causal, a bystander, or neurogenically induced by the stroke. AF after a stroke is a risk factor for thromboembolism and a strong marker for atrial myopathy. After acute ischemic stroke, patients should undergo 72 hours of electrocardiographic monitoring to detect AF. The diagnosis requires an ECG of sufficient quality for confirmation by a health professional with ECG rhythm expertise. AF detection rate is a function of monitoring duration and quality of analysis, AF episode definition, interval from stroke to monitoring commencement, and patient characteristics including old age, certain ECG alterations, and stroke type. Markers of atrial myopathy (eg, imaging, atrial ectopy, natriuretic peptides) may increase AF yield from monitoring and could be used to guide patient selection for more intensive/prolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non-vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non-vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated.

4.
Heart Rhythm ; 15(11): 1601-1607, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29981863

RESUMO

BACKGROUND: Chronic anticoagulation is recommended for atrial fibrillation (AF) patients with thromboembolic risk factors regardless of AF duration/frequency. Continuous rhythm assessment with pacemakers (PMs)/implantable cardioverter-defibrillators (ICDs) and use of direct-acting oral anticoagulants (DOACs) may allow anticoagulation only around AF episodes, reducing bleeding without increasing thromboembolic risk. OBJECTIVE: The purpose of this study was to evaluate the feasibility/safety of intermittent DOAC use guided by continuous remote AF monitoring via dual-chamber PMs or ICDs. METHODS: Patients with nonpermanent AF, current DOAC use, CHADS2 score ≤3, a St. Jude Medical dual-chamber PM or ICD, and rare AF episodes were followed with biweekly and AF-alert based remote transmissions. Patients free of AF episodes lasting ≥6 minutes with a total AF burden <6 hours/day for 30 consecutive days discontinued DOAC. If AF burden surpassed these limits, DOAC was restarted and/or continued. Total days on DOAC and adverse events were assessed. RESULTS: Among 48 patients (mean age 71.3 years; 65% male; 79% paroxysmal AF; 87% CHADS2 score 1-2), 14,826 days of monitoring were completed. Patients used DOACs for 3763 days, representing a 74.6% reduction in anticoagulation time compared to chronic administration. Adverse events included 2 gastrointestinal bleeds (both on DOAC), 1 fatal intracerebral bleed (off DOAC), and no thromboembolic/stroke events. CONCLUSION: Among patients with rare AF episodes and low-to-moderate stroke risk, PM/ICD-guided DOAC administration is feasible and decreased anticoagulation utilization by 75%. Few adverse events occurred, although the study was not powered to assess these outcomes. PM/ICD-guided DOAC administration may prove a viable alternative to chronic anticoagulation. Future studies are warranted.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/terapia , Desfibriladores Implantáveis , Monitorização Fisiológica/métodos , Marca-Passo Artificial , Acidente Vascular Cerebral/prevenção & controle , Telemetria/métodos , Idoso , Fibrilação Atrial/complicações , Relação Dose-Resposta a Droga , Eletrocardiografia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Projetos Piloto , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
6.
Heart Rhythm ; 15(3): 376-383, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29122724

RESUMO

BACKGROUND: In patients with cardiac implanted electronic devices, detection of new atrial fibrillation (AF) is associated with an increased risk of stroke. OBJECTIVE: To characterize daily AF burden at first detection and the rate of temporal transition to higher device-detected AF burden. METHODS: A pooled analysis of data from 3 prospective projects was analyzed, and 6580 patients (mean age 68 ± 12 years, 72% male) with no history of AF and no use of anticoagulants at baseline were identified. Various thresholds of daily AF burden (5 minutes and 1, 6, 12, and 23 hours) were analyzed. RESULTS: Among the study population of 6580 patients, a new AF, with an AF burden of ≥5 minutes, was detected in 2244 patients (34%) during a follow-up period of 2.4 ± 1.7 years. Among these patients, 1091 (49.8%) transitioned to a higher AF-burden threshold during follow-up. A higher duration of daily AF burden manifest at first detection and CHADS2 score ≥2 were associated with faster transition to a subsequent higher burden. Approximately 24% of patients transitioned from a lower threshold to a daily AF burden of ≥23 hours during follow-up. CONCLUSION: More than one-third of patients with no history of AF developed device-detected AF, with attainment of different thresholds of daily AF burden over time. Continuous long-term monitoring, especially when the initial detection corresponds to a higher daily AF burden and the CHADS2 score is ≥2, could support timely clinical decisions on anticoagulation by capturing transitions to higher AF-burden thresholds.


Assuntos
Fibrilação Atrial/diagnóstico , Desfibriladores Implantáveis , Técnicas Eletrofisiológicas Cardíacas/métodos , Medição de Risco/métodos , Acidente Vascular Cerebral/epidemiologia , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Taxa de Sobrevida/tendências , Fatores de Tempo
7.
Europace ; 19(9): 1556-1578, 2017 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-28934408
8.
Clin Cardiol ; 40(11): 1044-1048, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28800149

RESUMO

BACKGROUND: Atrial fibrillation (AF) burden and duration are predictors of thromboembolic events. The random nature of these measures may affect clinical decision making. The objective of this study was to determine temporal changes in AF burden as detected by continuous monitoring. HYPOTHESIS: AF burden changes over time when detected by continuous monitoring. METHODS: A post hoc analysis of patients enrolled in the TRENDS (A Prospective Study of the Clinical Significance of Atrial Arrhythmias Detected by Implanted Device Diagnostics) study with ≥1 stroke risk factor(s) who were implanted with a dual-chamber cardiac rhythm management device (CRMD) and had AF burden data available for ≥2 years was performed. AF burden was defined as no AF, low AF (<5.5 hours on any given day), or high AF burden (≥5.5 hours in a day), and was first assessed over the initial 30 days following enrollment and then reassessed at 6-month intervals for 2 years. RESULTS: Among 394 patients included, the average age was 70.2 ± 10.9 years, 71% were male, and mean CHA2 DS2- VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or TIA, vascular disease, age 65-74 years, sex category) score was 3.7 ± 1.6. In the 30-day baseline period, 75.1% of patients had no AF, 11.2% had low AF, and 13.7% had high AF. Over the subsequent 2 years, 40.0% of patients initially classified as no AF or low AF experienced periods with high AF, whereas 59.3% of patients initially classified as high AF experienced ≥6 consecutive months with no AF or low AF. Advanced age was the sole predictor of AF progression. CONCLUSIONS: Significant temporal variability in AF burden exists when measured continuously with an implantable CRMD.


Assuntos
Fibrilação Atrial/diagnóstico , Dispositivos de Terapia de Ressincronização Cardíaca , Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Insuficiência Cardíaca/terapia , Frequência Cardíaca , Monitorização Ambulatorial/instrumentação , Telemetria/instrumentação , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/fisiopatologia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do Tratamento
9.
Nat Rev Cardiol ; 14(12): 701-714, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28682320

RESUMO

Cardiac implanted electronic devices (CIEDs), including pacemakers and implantable defibrillators that perform atrial sensing typically using an atrial electrode, frequently detect subclinical atrial high-rate episodes (AHREs). When the intracardiac electrograms are carefully examined, the majority of AHREs are atrial fibrillation (AF) or other atrial tachyarrhythmias, which have been shown to be associated with both an increased risk of stroke, and subsequent development of clinical AF. However, the absolute risk of stroke among patients with AHREs is less than might be expected for clinically diagnosed paroxysmal AF. In addition, a close temporal relationship between AHREs and stroke is seen in only 15% of strokes in patients with a CIED: the majority have either no AHREs before the stroke, or AHREs very distant from incident stroke, suggesting that AHREs might be more of a risk marker than a risk factor for stroke. Management of AHREs should not be the same as for clinical AF, and a degree of uncertainty underpins the rationale for much-needed, ongoing, randomized trials of oral anticoagulation in patients with CIED-detected AHREs. We propose a management algorithm that takes into account both the stroke risk and the AHRE burden, but highlights the current uncertainty and evidence gaps for this condition.


Assuntos
Fibrilação Atrial/terapia , Desfibriladores Implantáveis , Gerenciamento Clínico , Átrios do Coração/fisiopatologia , Frequência Cardíaca/fisiologia , Marca-Passo Artificial , Fibrilação Atrial/fisiopatologia , Eletrocardiografia , Humanos , Fatores de Risco
10.
Circulation ; 135(19): 1851-1867, 2017 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-28483832

RESUMO

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Internacionalidade , Programas de Rastreamento/métodos , Humanos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle
11.
Can J Cardiol ; 31(8): 1004-11, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26076964

RESUMO

BACKGROUND: CHA2DS2-VASc and CHADS2 scores were derived and validated for stroke-risk stratification in patients who have a diagnosis of atrial fibrillation (AF). We hypothesized that these scores would predict adverse cardiovascular events even in the absence of AF. METHODS: The CHA2DS2-VASc and CHADS2 scores for 2010 patients with sick sinus syndrome who underwent pacemaker implantation and were enrolled in the Mode Selection Trial (MOST) were calculated. The association of these risk scores with main trial end points, including the composite of death and stroke, were evaluated to determine whether the associations differed by history of AF. RESULTS: Of the 2010 patients, 12% had a CHA2DS2-VASc score of 0-1, 16% had a score of 2, 41% had a score of 3-4, and 31% had a score ≥ 5 (the distribution for CHADS2 was similar); 42% had a clinical history of AF. Both scores were associated with death or stroke (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.05-1.23 for each 1-point increase in CHA2DS2-VASc; P = 0.001; HR, 1.11; 95% CI, 1.02-1.21 for each 1-point increase in CHADS2; P = 0.016). Association of scores with outcomes of death, stroke, and heart failure hospitalization were not different for patients with vs those without a history of AF (interaction P ≥ 0.55 for CHA2DS2-VASc and ≥ 0.30 for CHADS2). CONCLUSIONS: Both CHA2DS2-VASc and CHADS2 scores predict risk of death or stroke in patients with sick sinus syndrome, regardless of AF history. These scores could be risk-stratification tools for clinical events that might respond to new therapies­ie, anticoagulation or other interventions­even in the absence of AF.


Assuntos
Fibrilação Atrial/terapia , Marca-Passo Artificial/efeitos adversos , Sistema de Registros , Medição de Risco , Síndrome do Nó Sinusal/terapia , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Feminino , Humanos , Incidência , Masculino , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/epidemiologia , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
13.
J Atr Fibrillation ; 8(4): 1326, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27957232

RESUMO

The advent of cardiac implanted electronic devices with accurate atrial arrhythmia diagnostic capabilities has revealed a large burden of "silent " atrial fibrillation that is present in the cardiac population. Many studies have been completed, and many more are ongoing, to determine the correct treatment course when these atrial arrhythmias are detected. Alongside the development of accurate atrial diagnostics within the devices, has been the growth an entire network of wireless home monitoring capability. It is now possible to see, over the internet, individual patients' atrial arrhythmia burden on every day. This capability has tremendous promise for patient care, with the possibility of reducing strokes, decreasing heart failure, preventing cardiomyopathies, and likely substantially reducing health care costs. As this innovative diagnostic capability is generating large amounts of data, protocols for what should be done with the plethora of new information are being developed. In the pages that follow, we will present what is known about home monitoring for silent atrial fibrillation, and present the results of recent studies published in this arena.

14.
Heart Rhythm ; 12(1): 234-41, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25285649

RESUMO

BACKGROUND: Stroke without an identifiable cause is frightening to patients and their families and is frustrating for the caring physician. Approximately 30% of patients with cardiac implanted electronic devices have some evidence of atrial fibrillation (AF), and much of it is silent: asymptomatic, and previously unrecognized. OBJECTIVE: The purpose of this review is to examine "silent AF" as a potential cause of cryptogenic stroke. METHODS/RESULTS: We begin by reviewing most of the published literature on screening for AF with different monitoring technologies in the setting of cryptogenic stroke. We present the results of 2 recent large randomized trials, CRYSTAL AF and EMBRACE, which compare standard of care monitoring in cryptogenic stroke patients to invasive and noninvasive monitoring strategies, respectively. Finally, we review the relationship of silent AF to stroke in the cardiac implanted electronic device population. Patient selection, duration of monitoring, sensitivity and specificity of monitoring technology, patient compliance, and several other factors affect the yield of AF detection during monitoring. CONCLUSION: Data suggest that silent AF is identified in approximately 30% of cryptogenic stroke patients and has important therapeutic implications. Oral anticoagulation likely should be prescribed when silent AF is detected.


Assuntos
Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Acidente Vascular Cerebral/etiologia , Fibrilação Atrial/terapia , Eletrocardiografia Ambulatorial , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/prevenção & controle
16.
J Am Coll Cardiol ; 63(25 Pt A): 2840-8, 2014 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-24814497

RESUMO

OBJECTIVES: This study aimed to identify how accurately the current clinical atrial fibrillation (AF) classifications reflect its temporal persistence. BACKGROUND: Clinical classification of AF is employed to communicate its persistence, to select appropriate therapies, and as inclusion criterion for clinical trials. METHODS: Cardiac rhythm histories of 1,195 patients (age 73.0 ± 10.1 years, follow-up: 349 ± 40 days) with implantable devices were reconstructed and analyzed. Patients were classified as having paroxysmal or persistent AF by physicians at baseline in accordance with current guidelines. AF burden, measured as the proportion of time spent in AF, was obtained from the device. Additionally we evaluated the agreement between clinical and device-derived AF classifications. RESULTS: Patients within the same clinical class were highly heterogeneous with regards to AF temporal persistence. Agreement between the clinical AF classification and the objective device-derived assessments of AF temporal persistence was poor (Cohen's kappa: 0.12 [95% CI: 0.05 to 0.18]). Patient characteristics influenced the clinical decision to classify AF as paroxysmal or persistent. Higher ejection fraction (odds ratio: 0.97/per unit [95% CI: 0.95 to 0.98/per unit]; p < 0.0001) and presence of coronary artery disease (odds ratio: 0.53 [95% CI: 0.32 to 0.88]; p = 0.01) were independently associated with a lower probability of being classified as persistent AF for the same AF burden level. CONCLUSIONS: The currently used clinical AF classifications poorly reflect AF temporal persistence. Patient characteristics significantly influence the physician's classification of AF. Patients classified in identical clinical categories may be inherently heterogeneous with regard to AF temporal persistence. Further study is required to determine if patient selection on the basis of objective criteria derived from rigorous AF monitoring can improve reported outcomes and better identify responders and non-responders to treatments. (OMNI Study-Assessing Therapies in Medtronic Pacemaker, Defibrillator, and Cardiac Resynchronization Therapy Devices; NCT00277524; TRENDS: A Prospective Study of the Clinical Significance of Atrial Arrhythmias Detected by Implanted Device Diagnostics; NCT00279981).


Assuntos
Fibrilação Atrial/classificação , Dispositivos de Terapia de Ressincronização Cardíaca , Frequência Cardíaca/fisiologia , Monitorização Fisiológica/métodos , Idoso , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
17.
Cardiol Clin ; 32(2): 271-81, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24793802

RESUMO

The precise role atrial fibrillation (AF) plays in increasing the risk of stroke is less well understood; this is especially true for the implanted device population. Current cardiac implanted electronic devices have a very high sensitivity and specificity for true AF detection. It does not seem to matter if the AF episode is proximal to the stroke event, and risk seems to be increased by relatively brief AF episodes. The appearance of new atrial high-rate episodes increases thromboembolic event rates. Until larger trials or registries are conducted, it is important to follow established guidelines regarding anticoagulation.


Assuntos
Fibrilação Atrial/diagnóstico , Desfibriladores Implantáveis , Fibrilação Atrial/mortalidade , Ensaios Clínicos como Assunto , Previsões , Humanos , Estimativa de Kaplan-Meier , Medição de Risco , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/mortalidade , Tromboembolia/prevenção & controle
18.
Eur Heart J ; 35(8): 508-16, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24334432

RESUMO

OBJECTIVE: The aim of this study was to assess the association between maximum daily atrial fibrillation (AF) burden and risk of ischaemic stroke. BACKGROUND: Cardiac implanted electronic devices (CIEDs) enhance detection of AF, providing a comprehensive measure of AF burden. DESIGN, SETTING, AND PATIENTS: A pooled analysis of individual patient data from five prospective studies was performed. Patients without permanent AF, previously implanted with CIEDs, were included if they had at least 3 months of follow-up. A total of 10 016 patients (median age 70 years) met these criteria. The risk of ischaemic stroke associated with pre-specified cut-off points of AF burden (5 min, 1, 6, 12, and 23 h, respectively) was assessed. RESULTS: During a median follow-up of 24 months, 43% of 10 016 patients experienced at least 1 day with at least 5 min of AF burden and for them the median time to the maximum AF burden was 6 months (inter-quartile range: 1.3-14). A Cox regression analysis adjusted for the CHADS2 score and anticoagulants at baseline demonstrated that AF burden was an independent predictor of ischaemic stroke. Among the thresholds of AF burden that we evaluated, 1 h was associated with the highest hazard ratio (HR) for ischaemic stroke, i.e. 2.11 (95% CI: 1.22-3.64, P = 0.008). CONCLUSIONS: Device-detected AF burden is associated with an increased risk of ischaemic stroke in a relatively unselected population of CIEDs patients. This finding may add to the basis for timely and clinically appropriate decision-making on anticoagulation treatment.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Desfibriladores Implantáveis , Acidente Vascular Cerebral/prevenção & controle , Idoso , Anticoagulantes/uso terapêutico , Efeitos Psicossociais da Doença , Feminino , Humanos , Ataque Isquêmico Transitório/prevenção & controle , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Estudos Prospectivos , Fatores de Risco
19.
Can J Cardiol ; 29(7 Suppl): S14-23, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23790594

RESUMO

The term "silent" atrial fibrillation (AF) has recently re-emerged to describe atrial arrhythmias that are detected by implanted cardiac devices but would generally go undetected in the clinical setting. The precise role that silent AF plays in increasing the risk of ischemic stroke is not fully understood. The purpose of this article is to: (1) review the current evidence demonstrating that silent AF is associated with thromboembolic events; (2) describe the temporal proximity of silent AF episodes to thromboembolic events; (3) present data on the incidence of newly detected silent AF in patients without a previous history of AF; and (4) provide an overview of ongoing and new clinical studies on this important topic. The current evidence suggests that the prevalence of silent AF is considerable among patients with implanted devices, and that the presence of silent AF increases the risk of thromboembolism. The AF burden threshold which confers this increased thromboembolism risk is not precisely defined, but might be as brief as several minutes to several hours. The advent of novel oral anticoagulation medications, which offer the promise of improved efficacy along with superior safety profiles, might warrant more aggressive identification of patients who might benefit from these therapies. However, to find high risk patients who have brief episodes of silent AF will likely require new methods of monitoring to permit the detection of this elusive but potentially dangerous arrhythmia.


Assuntos
Anticoagulantes , Doenças Assintomáticas , Fibrilação Atrial , Prevalência , Acidente Vascular Cerebral , Tromboembolia , Administração Oral , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Anticoagulantes/classificação , Doenças Assintomáticas/epidemiologia , Doenças Assintomáticas/terapia , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Estimulação Cardíaca Artificial/métodos , Ensaios Clínicos como Assunto , Monitoramento de Medicamentos/métodos , Eletrocardiografia Ambulatorial/métodos , Humanos , Incidência , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Fatores de Tempo
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