Natural History of Subclinical Atrial Fibrillation Detected by Implanted Loop Recorders

Diederichsen, Søren Zöga; Haugan, Ketil; Brandes, Axel; Lanng, Mathias Buus; Graff, Claus; Krieger, Derk; Kronborg, Christian; Holst, Anders; Køber, Lars; Højberg, Søren; Svendsen, Jesper Hastrup

doi:10.1016/j.jacc.2019.09.050

Cited by 90 publications

(65 citation statements)

References 27 publications

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“…Continuous ECG monitoring can provide new evidence for the heterogeneity of AF. 11 Our study extends these findings by proposing three patterns of paroxysmal self-terminating AF based on the duration of the longest episode. Yet, these cut-off values will need to be validated in future studies.…”

Section: Discussionsupporting

confidence: 74%

Temporal patterns and short-term progression of paroxysmal atrial fibrillation: data from RACE V

Investigators

Erküner

Rienstra³

et al. 2020

EP Europace

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Abstract Aims Atrial fibrillation (AF) often starts as a paroxysmal self-terminating arrhythmia. Limited information is available on AF patterns and episode duration of paroxysmal AF. In paroxysmal AF patients, we longitudinally studied the temporal AF patterns, the association with clinical characteristics, and prevalence of AF progression. Methods and results In this interim analysis of the Reappraisal of AF: Interaction Between HyperCoagulability, Electrical Remodelling, and Vascular Destabilisation in the Progression of AF (RACE V) registry, 202 patients with paroxysmal AF were followed with continuous rhythm monitoring (implantable loop recorder or pacemaker) for 6 months. Mean age was 64 ± 9 years, 42% were women. Atrial fibrillation history was 2.1 (0.5–4.4) years, CHA2DS2-VASc 1.9 ± 1.3, 101 (50%) had hypertension, 69 (34%) heart failure. One-third had no AF during follow-up. Patients with long episodes (>12 hours) were often men with more comorbidities (heart failure, coronary artery disease, higher left ventricular mass). Patients with higher AF burden (>2.5%) were older with more comorbidities (worse renal function, higher calcium score, thicker intima media thickness). In 179 (89%) patients, 1-year rhythm follow-up was available. On a quarterly basis, average daily AF burden increased from 3.2% to 3.8%, 5.2%, and 6.1%. Compared to the first 6 months, 111 (62%) patients remained stable during the second 6 months, 39 (22%) showed progression to longer AF episodes, 8 (3%) developed persistent AF, and 29 (16%) patients showed AF regression. Conclusions In paroxysmal AF, temporal patterns differ suggesting that paroxysmal AF is not one entity. Atrial fibrillation burden is low and determined by number of comorbidities. Atrial fibrillation progression occurred in a substantial number. Trial registration number Clinicaltrials.gov identifier NCT02726698.

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Section: Discussionsupporting

confidence: 74%

Temporal patterns and short-term progression of paroxysmal atrial fibrillation: data from RACE V

Investigators

Erküner

Rienstra³

et al. 2020

EP Europace

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“…Recently, several such tools have been developed specifically for AF, and preliminary data suggest a potential for improving AF management and patient outcomes using these tools. 5,23,24 Importantly, their output strongly depends on comprehensiveness (and accuracy) of AF-related and other health information entered for a given patient.…”

Section: Thrombosis and Haemostasismentioning

confidence: 99%

The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

et al. 2020

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Atrial fibrillation (AF) is a complex condition requiring holistic management with multiple treatment decisions about optimal thromboprophylaxis, symptom control (and prevention of AF progression), and identification and management of concomitant cardiovascular risk factors and comorbidity. Sometimes the information needed for treatment decisions is incomplete, as available classifications of AF mostly address a single domain of AF (or patient)-related characteristics. The most widely used classification of AF based on AF episode duration and temporal patterns (that is, the classification to first-diagnosed, paroxysmal, persistent/long-standing persistent, and permanent AF) has contributed to a better understanding of AF prevention and treatment but its limitations and the need for a multidimensional AF classification have been recognized as more complex treatment options became available. We propose a paradigm shift from classification toward a structured characterization of AF, addressing specific domains having treatment and prognostic implications to become a standard in clinical practice, thus aiming to streamline the assessment of AF patients at all health care levels facilitating communication among physicians, treatment decision-making, and optimal risk evaluation and management of AF patients. Specifically, we propose the 4S-AF structured pathophysiology-based characterization (rather than classification) scheme that includes four AF- and patient-related domains—Stroke risk, Symptoms, Severity of AF burden, and Substrate severity—and provide a hypothetical model for the use of 4S-AF characterization scheme to aid treatment decision making concerning the management of patients with AF in clinical practice.

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“…AF was ascertained through adjudicated, annual 12-lead electrocardiograms (ECGs) over long-term follow-up; hospital discharge diagnoses; and Medicare claims for AF. While this method may underestimate true incidence of AF, it has been validated in several populations, is easily translatable to clinical practice, and may represent clinically significant AF, as device-detected AF through continuous monitoring is of relatively low yield and uncertain clinical benefit (23). Nonetheless, the possibility of underestimation of AF incidence would tend to bias our results to null.…”

Section: L I N I C a L M E D I C I N Ementioning

confidence: 95%

Characterization of cardiac mechanics and incident atrial fibrillation in participants of the Cardiovascular Health Study

Patel¹,

Delaney²,

Hu³

et al. 2020

JCI Insight

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BACKGROUND. Left atrial (LA) and left ventricular (LV) remodeling are associated with atrial fibrillation (AF). The prospective associations of impairment in cardiac mechanical function, as assessed by speckle-tracking echocardiography, with incident AF are less clear. METHODS. In the Cardiovascular Health Study, a community-based cohort of older adults, participants free of AF with echocardiograms of adequate quality for speckle tracking were included. We evaluated the associations of indices of cardiac mechanics (LA reservoir strain, LV longitudinal strain, and LV early diastolic strain rate) with incident AF. RESULTS. Of 4341 participants with strain imaging, participants with lower LA reservoir strain were older, had more cardiometabolic risk factors, and had lower renal function at baseline. Over a median follow-up of 10 years, 497 (11.4%) participants developed AF. Compared with the highest quartile of LA reservoir strain, the lowest quartile of LA reservoir strain was associated with higher risk of AF after covariate adjustment, including LA volume and LV longitudinal strain (Hazard Ratio [HR], 1.80; 95% CI, 1.31-2.45; P < 0.001). The association of LA reservoir strain and AF was stronger in subgroups with higher blood pressure, NT-proBNP, and LA volumes. There were no associations of LV longitudinal strain and LV early diastolic strain rate with incident AF after adjustment for LA reservoir strain. CONCLUSION. Lower LA reservoir strain was associated with incident AF, independent of LV mechanics, and with stronger associations in high-risk subgroups. These findings suggest that LA mechanical dysfunction precedes the development of AF. Therapies targeting LA mechanical dysfunction may prevent progression to AF.

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Natural History of Subclinical Atrial Fibrillation Detected by Implanted Loop Recorders

Cited by 90 publications

References 27 publications

Temporal patterns and short-term progression of paroxysmal atrial fibrillation: data from RACE V

Temporal patterns and short-term progression of paroxysmal atrial fibrillation: data from RACE V

The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

Characterization of cardiac mechanics and incident atrial fibrillation in participants of the Cardiovascular Health Study

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