Detection of Previously Undiagnosed Atrial Fibrillation in Patients With Stroke Risk Factors and Usefulness of Continuous Monitoring in Primary Stroke Prevention

The detection of undiagnosed atrial tachycardia/atrial fibrillation (AT/AF) among patients with stroke risk factors could be useful for primary stroke prevention. We analyzed newly detected AT/AF (NDAF) using continuous monitoring in patients with stroke risk factors but without previous stroke or e...

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Bibliographic Details
Published in:The American journal of cardiology 2012-11, Vol.110 (9), p.1309-1314
Main Authors: Ziegler, Paul D., MS, Glotzer, Taya V., MD, Daoud, Emile G., MD, Singer, Daniel E., MD, Ezekowitz, Michael D., MD, PhD, Hoyt, Robert H., MD, Koehler, Jodi L., MS, Coles, James, PhD, Wyse, D. George, MD, PhD
Format: Article
Language:English
Subjects:
Age Distribution
Aged
Aged, 80 and over
Anti-Arrhythmia Agents - therapeutic use
Anticoagulants
Atrial Fibrillation - diagnosis
Atrial Fibrillation - epidemiology
Atrial Fibrillation - therapy
Biological and medical sciences
Cardiac arrhythmia
Cardiac dysrhythmias
Cardiac Resynchronization Therapy - methods
Cardiology. Vascular system
Cardiovascular
Cohort Studies
Combined Modality Therapy
Defibrillators, Implantable
Delayed Diagnosis
Diabetes
Female
Follow-Up Studies
Heart
Humans
Hypertension
Incidence
Kaplan-Meier Estimate
Male
Medical sciences
Middle Aged
Monitoring, Physiologic - methods
Neurology
Older people
Pacemaker, Artificial
Risk Factors
Severity of Illness Index
Sex Distribution
Stroke
Stroke - epidemiology
Stroke - physiopathology
Stroke - prevention & control
Survival Analysis
Treatment Outcome
Vascular diseases and vascular malformations of the nervous system
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Summary:The detection of undiagnosed atrial tachycardia/atrial fibrillation (AT/AF) among patients with stroke risk factors could be useful for primary stroke prevention. We analyzed newly detected AT/AF (NDAF) using continuous monitoring in patients with stroke risk factors but without previous stroke or evidence of AT/AF. NDAF (AT/AF >5 minutes on any day) was determined in patients with implantable cardiac rhythm devices and ≥1 stroke risk factors (congestive heart failure, hypertension, age ≥75 years, or diabetes). All devices were capable of continuously monitoring the daily cumulative time in AT/AF. Of 1,368 eligible patients, NDAF was identified in 416 (30%) during a follow-up of 1.1 ± 0.7 years and was unrelated to the CHADS2 score (congestive heart failure, hypertension [blood pressure consistently >140/90 mm Hg or hypertension treated with medication], age ≥75 years, diabetes mellitus, previous stroke or transient ischemic attack). The presence of AT/AF >6 hours on ≥1 day increased significantly with increased CHADS2 scores and was present in 158 (54%) of 294 patients with NDAF and a CHADS2 score of ≥2. NDAF was sporadic, and 78% of patients with a CHADS2 score of ≥2 with NDAF experienced AT/AF on 6 hours on ≥1 days in most patients with NDAF and multiple stroke risk factors. Whether patients with CHADS2 risk factors but without a history of AF might benefit from implantable monitors for the selection and administration of anticoagulation for primary stroke prevention merits additional investigation.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2012.06.034