Cited by 380Atrial Fibrillation Management and OutcomesAcute Ischemic Stroke ManagementVenous Thromboembolism Diagnosis and Management

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

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BOTTO, GIOVANNI L., PADELETTI, LUIGI, SANTINI, MASSIMO, CAPUCCI, ALESSANDRO, GULIZIA, MICHELE, ZOLEZZI, FRANCESCO, FAVALE, STEFANO, MOLON, GIULIO, RICCI, RENATO, BIFFI, MAURO, RUSSO, GIOVANNI, VIMERCATI, MARCO, CORBUCCI, GIORGIO, BORIANI, GIUSEPPE·2009·Journal of Cardiovascular Electrophysiology

DOI 10.1111/j.1540-8167.2008.01320.x

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Abstract

INTRODUCTION: Asymptomatic atrial fibrillation (AF) can expose patients to the risk of stroke. The primary objective of this study was to assess the incidence of thromboembolic events in relationship with CHADS(2) (congestive heart failure, hypertension, age >or=75 years, diabetes mellitus, and prior stroke, or transient ischemic attack) score and AF presence/duration. The secondary objective was to compare intermittent versus continuous monitoring strategies. METHODS AND RESULTS: Data from patients with an implanted pacemaker and a history of AF were analyzed. Thromboembolic risk was quantified through CHADS(2) score. Three AF groups were considered: patients with <5-minutes AF on 1 day (AF-free); patients with >5-minutes AF on 1 day but <24 hours (AF-5 minutes); patients with AF episodes >24 hours (AF-24 hours). Monitoring strategies involving 24-hour Holter, 1-week Holter, and 30-day Holter were simulated. Data from 568 patients continuously monitored for 1 year were analyzed: 171 (30%) had CHADS(2) score = 0; 269 (47%) had CHADS(2) score = 1; 111 (20%) had CHADS(2) score = 2; and 17 (3%) had CHADS(2) score >or= 3. During follow-up, 14 patients (2.5%) had an ischemic thromboembolic event. AF-24 hours patients numbered 223 (39.2%); AF-5 minutes, 179 (31.5%); and AF-free, 29.2%. By combining AF presence/duration with CHADS(2) score, two subpopulations with markedly different risks of events (0.8% vs 5%, P = 0.035) were identified, the former corresponding to AF-free with CHADS(2) 5 minutes was 44.4%, 50.4%, and 65.1% for 24-hour Holter, 1-week Holter, and 1-month Holter monitoring, respectively. CONCLUSION: In patients with recurrent AF episodes, risk stratification for thromboembolic events can be improved by combining CHADS(2) score with AF presence/duration.

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Authors: BOTTO, G. L., PADELETTI, L., SANTINI, M., CAPUCCI, A., GULIZIA, M., ZOLEZZI, F., FAVALE, S., MOLON, G., RICCI, R., BIFFI, M., RUSSO, G., VIMERCATI, M., CORBUCCI, G., & BORIANI, G.
Affiliations: Ospedale Sant'Anna (IT)
University of Florence (IT)
Ospedale San Filippo Neri (IT)
Guglielmo da Saliceto Hospital (IT)
Ospedale Garibaldi (IT)
Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT)
Ospedale Sacro Cuore Don Calabria (IT)
IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
Medtronic (Italy) (IT)
Corresponding author: BOTTO, GIOVANNI L.
RUSSO, GIOVANNI
ORCID: BOTTO, GIOVANNI L.
GULIZIA, MICHELE
FAVALE, STEFANO
MOLON, GIULIO
RICCI, RENATO
BIFFI, MAURO
BORIANI, GIUSEPPE
Venue: Journal of Cardiovascular Electrophysiology
Publisher: Wiley
Published: 2009-02-20
Volume: 20
Issue: 3
Pages: 241-248
ISSN: 1045-3873 (ISSN-L)
1540-8167
DOI: 10.1111/j.1540-8167.2008.01320.x
OpenAlex: W2075749661
Cited by: 380
References: 40
Citations by year: 2026: 4 · 2025: 3 · 2024: 15 · 2023: 17 · 2022: 16 · 2021: 21 · 2020: 19 · 2019: 19 · 2018: 37 · 2017: 31 · 2016: 30 · 2015: 39 · 2014: 27 · 2013: 30 · 2012: 26
FWCI: 11.16
Type: journal article
Language: en
Open access: green
hdl.handle.net
Licence: cc-by
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Journal of Cardiovascular Electrophysiology (publishedVersion)
PubMed (publishedVersion)
Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
Florence Research (University of Florence) (submittedVersion)
IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion)
CINECA IRIS Institutional Research Information System (University of Bari Aldo Moro) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Keywords: atrial fibrillation, thromboembolic risk, CHADS2 score, atrial fibrillation duration, continuous cardiac monitoring, Holter monitoring, intermittent monitoring, stroke risk stratification, implantable pacemaker, asymptomatic atrial fibrillation, anticoagulation, antiplatelet therapy, antiarrhythmic drugs, catheter ablation
MeSH terms: Aged, Atrial Fibrillation, Female, Humans, Italy, Male, Prognosis, Risk Factors, Thromboembolism, Electrocardiography, Ambulatory, Comorbidity, Incidence, Risk Assessment

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

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