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Presence and Duration of Atrial Fibrillation Detected by Continuous Monitoring: Crucial Implications for the Risk of Thromboembolic Events
Open accessAbstract
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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“However, it must be underlined that once atrial fibrillation has been diagnosed as a cause of palpitations, there is up to now only limited data on the importance of assessing atrial fibrillation burden for the evaluation of thromboembolic risk, and more information is still needed.67,91”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [67]
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Cites
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Ommen, S. R., Mital, S. R., Burke, M. A., Day, S. M., Deswal, A. M., Elliot, P. M., Evanovich, L. L., Hung, J., Joglar, J. A., Kantor, P. F., et al. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.08.044 · Cited by 997
Antithrombotic Therapy for Atrial Fibrillation
Lip, G. Y. H., Banerjee, A., Boriani, G., Chiang, C. E., Fargo, R. A., Freedman, B., Lane, D. A., Ruff, C. T., Turakhia, M. P., Werring, D. J., et al. (2018) · CHEST Journal · doi:10.1016/j.chest.2018.07.040 · Cited by 963
Self-citation2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933
Ommen, S. R., Ho, C. Y., Asif, I. M., Balaji, S., Burke, M. A., Day, S. M., Dearani, J. A., Epps, K. C., Evanovich, L., Ferrari, V. A., et al. (2024) · Circulation · doi:10.1161/cir.0000000000001250 · Cited by 807
Metadata
- 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
- 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
- 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
- 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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