Presence and Duration of Atrial Fibrillation Detected by Continuous Monitoring: Crucial Implications for the Risk of Thromboembolic Events

Botto, Giovanni Luca; Padeletti, Luigi; Santini, Massimo; Capucci, Alessandro; Gulizia, Michele Massimo; Zolezzi, F; Favale, Stefano; Molon, Giulio; Ricci, Renato Pietro; Biffi, Mauro; Russo, Giovanni; Vimercati, Marco; Corbucci, Giorgio; Boriani, Giuseppe

doi:10.1111/j.1540-8167.2008.01320.x

Cited by 344 publications

(275 citation statements)

References 40 publications

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“…An interesting observation supporting the hypothesis of a multivariable model and the absence of a fixed threshold predictive of increased risk is suggested from a proof-of-concept study in which the risk of stroke or TE events was found to be not only a function of the time spent in AF, but also of the baseline characteristics of the patients. 48 In this study, in patients with a high CHADS 2 score, even short episodes of AF significantly increased the rate of TE events; whereas in patients with a very low CHADS 2 score, even long episodes of AF did not.…”

Section: Af Burden and Risk Of Strokementioning

confidence: 44%

Detection and management of atrial fibrillation after cryptogenic stroke or embolic stroke of undetermined source

Sanna

Ziegler

Crea

2018

Clinical Cardiology

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Cryptogenic stroke (CS) and embolic stroke of unknown source (ESUS) represent a major challenge to healthcare systems worldwide. Atrial fibrillation (AF) is commonly found after CS or ESUS. Independent of the mechanism of the index CS or ESUS, detection of AF in these patients offers the opportunity to reduce the risk of stroke recurrence by prescribing an anticoagulant instead of aspirin. The detection of AF may be pursued with different monitoring strategies. Comparison of monitoring strategies should take into account that AF detection rates reported in published studies, and then pooled in meta-analyses, are not only a function of the monitoring strategy itself, but also depend on patient-related, device-related, and study design-related factors. Once AF is found, the decision to anticoagulate a patient should be made on the basis of AF burden and the baseline risk of the patient. Empirical anticoagulation in patients with ESUS and no evidence of AF is an intriguing but still-unproven strategy and therefore should not be adopted outside of randomized clinical trials.Each year, >790 000 people experience a new or recurrent stroke in the United States. 1 The cause of ischemic stroke remains undetermined after hospitalization in 10% to 40% of cases; this is often referred to as "cryptogenic" stroke (CS). 2 Differences in the definition and diagnostic workup contribute to this variable incidence in published series. To mitigate this limitation, the term "embolic stroke of undetermined source" (ESUS) has recently been proposed to identify those cases where the etiology of nonlacunar ischemic stroke remains elusive after a standardized diagnostic pathway. 3 The prevalence of ESUS was 16% to 32% in a recently published series. 4 Hence, even after a standardized comprehensive evaluation, the cause of ischemic stroke remains elusive in a significant proportion of patients, thus representing a major challenge for treatment selection. | STROKE RECURRENCE IN PATIENTS WITH PRIOR CS AND ESUSIn a recent study, patients with CS had an ischemic stroke recurrence rate of 9.1% (range, 6.2%-12.0%), 24.0% (range, 19.1%-28.9%), and 31.9% (range, 25.2%-38.6%) at 1, 5, and 10 years, respectively. 5 Recurrent stroke in these patients was classified again as cryptogenic in 63% of cases. 5 Stroke recurrence rate in ESUS was also reported to be high and similar to CS. 6 Possible causes of stroke recurrence, irrespective of the mechanism of the index stroke, are paroxysmal atrial fibrillation (AF), arterial sources of thromboembolism (TE), patent foramen ovale (PFO), cardiac structural abnormalities, and other less common etiologies. Detection of AF after a CS or ESUS does not imply causality but still offers an opportunity for reducing the risk of stroke recurrence by prescribing oral anticoagulation (OAC). However, AF is often asymptomatic, paroxysmal, and difficult to detect with conventional tools. Several monitoring strategies have been investigated to detect asymptomatic AF after an ischemic stroke, including electrocardiography (...

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Section: Af Burden and Risk Of Strokementioning

confidence: 44%

Detection and management of atrial fibrillation after cryptogenic stroke or embolic stroke of undetermined source

Sanna

Ziegler

Crea

2018

Clinical Cardiology

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“…И если мы сопостав-ляем данные о наличии и продолжительности запи-санных эпизодов ФП с показателями CHADS 2 каж-дого пациента, мы можем идентифицировать две группы пациентов, которые существенно отличаются по тромбоэмболическим профилям риска (0,8% про-тив 5%, p=0,035) (рис. 1) [9][10][11].…”

Section: сложности в определении групп риска больных с фпunclassified

The Unresolved Issues and Modern View on Atrial Fibrillation Patients Management

Лосик¹,

Байрамова²,

Покушалов³

et al. 2017

Russ J Cardiol

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“…The state of Goias, in central Brazil, has a CD prevalence higher than national average [3,6]. Furthermore, most of our patients lived in rural areas since an early age and were subsequently exposed to the CD vector.…”

Section: Recorded Parametersmentioning

confidence: 99%

“…The estimated cost of the combined medical and surgical treatment of an infected, pacemakerdefibrillator system in the United States was ∼$35,000 [6]. The resultant financial burden necessitates that a better understanding of the risk factors for PPM infection be achieved so that effective preventive strategies may be developed.…”

Section: Risk Factor Of Permanentmentioning

confidence: 99%

Pacemaker Patients with High Level of Risk

Sabr¹

2016

International Journal of Innovative Research in Electrical, Ele

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Abstract:In this paper, Cardiac pacing is a safe and effective therapy for multiple bradyarrhythmic conditions [1]. However, incorrect perceptions about the safety of daily activities (SODA) may impair patients' absolute well-being [2]. Chagas' disease (CD) is a chronic protozoan infection caused by Trypanosoma cruzi. Cardiac compromise occurs in up to 30% of CD patients and can manifest as severe bradyarrhythmias. erforated ICD leads were 7F in six of seven ICD patients, whereas only one 9F ICD was represented in our series. The majority of perforated electrodes were active fixation screw in leads.

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Presence and Duration of Atrial Fibrillation Detected by Continuous Monitoring: Crucial Implications for the Risk of Thromboembolic Events

Abstract: In patients with recurrent AF episodes, risk stratification for thromboembolic events can be improved by combining CHADS(2) score with AF presence/duration.

Cited by 344 publications

References 40 publications

Detection and management of atrial fibrillation after cryptogenic stroke or embolic stroke of undetermined source

Detection and management of atrial fibrillation after cryptogenic stroke or embolic stroke of undetermined source

The Unresolved Issues and Modern View on Atrial Fibrillation Patients Management

Pacemaker Patients with High Level of Risk

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