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February 3, 2023Journal of Interventional Cardiac ElectrophysiologyOpen Access

Device-detected atrial fibrillation in a large remote-monitored cohort: implications for anticoagulation and need for new pathways of service delivery

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Key result

Intensive remote management leaves ~31% of high-risk patients with device-detected AF unanticoagulated.

  • n=7,651

Why the study?

The burden of remote monitoring AF alerts and its impact on anticoagulation in patients with device-detected AF needed characterization.

Population

7651 consecutive CIED patients with at least one AF episode undergoing remote monitoring

Design

Cohort study

Follow-up

twelve-months

Authors

COCatherine O’SheaElectrophysiologyABAnthony G. BrooksElectrophysiologyMMMelissa E. MiddeldorpElectrophysiology

Discussion

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Implication

Persistent anticoagulation gaps in high-risk device-detected AF persist despite remote monitoring; leaves open optimal implementation strategies for prospective study.

Study Design

Type

Cohort (n=7,651)

Multicenter

Yes

Structured PICO

P
Population
7,651 consecutive patients with a cardiac implantable electronic device (CIED) and at least one atrial fibrillation (AF) episode undergoing remote monitoring. Average age 74 ± 12 years. Device types included permanent pacemakers (40.8%), implantable loop recorders (29.5%), implantable cardioverter defibrillators (12.9%), CRT defibrillators (12.7%), and CRT pacemakers (4.1%).
I
Intervention
Remote monitoring via automated software system (PaceMate) providing rapid alert processing by device specialists and systematic, recurrent prompts for anticoagulation to clinic staff over a 12-month period.
O
Outcome
Anticoagulation status at the close of the 12-month monitoring period in patients with device-detected AF episodes of significant duration and elevated estimated CHA2DS2-VASc score.

Despite intensive remote monitoring and automated prompts, a substantial proportion of high-risk patients with device-detected AF remain unanticoagulated, highlighting a gap in clinical response pathways.

Limitations

  • Limited baseline characteristics with no data on hypertension, diabetes mellitus, stroke, vascular disease, or sex
  • Potential underestimation of CHA2DS2-VASc scores due to missing clinical variables
  • Lack of data regarding procedural interventions such as left atrial appendage occlusion
  • Inability to definitively exclude non-AF rhythms without individual electrogram review
  • Limited baseline characteristics preventing definitive CHA2DS2-VASc score calculation
  • Missing sex data in a significant proportion of the cohort
  • Lack of data regarding procedural interventions like left atrial appendage occlusion
  • Absence of individual electrogram review meaning potential inclusion of non-AF rhythms

Cite This Study

O’Shea et al. (2023) conducted a cohort in Device-detected atrial fibrillation (n=7,651). Remote monitoring with automated software system was evaluated on Unanticoagulated status at 12 months in patients with AF episode ≥ 6 hours and minimum CHA2DS2-VASc score of 2. Despite intensive management via a remote monitoring software system, 31.2% of patients with a device-detected atrial fibrillation episode of ≥6 hours and a minimum CHA2DS2-VASc score of 2 remained unanticoagulated.

synapsesocial.com/papers/6a1552385347fbb1739f96a7https://doi.org/10.1007/s10840-023-01481-4

Topics

Atrial fibrillationAnticoagulation in AFPersistent AF managementCardiac device therapyAF ablation outcomes
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Use of Oral Anticoagulation in a Real‐World Population With Device Detected Atrial Fibrillation2020 · 6 citations
  2. 2Stroke Risk as a Function of Atrial Fibrillation Duration and CHA 2 DS 2 -VASc Score2019 · 286 citations
  3. 3Association of Burden of Atrial Fibrillation With Risk of Ischemic Stroke in Adults With Paroxysmal Atrial Fibrillation2018 · 293 citations
  4. 4The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) Trial2011 · 532 citations
  5. 5International trends in clinical characteristics and oral anticoagulation treatment for patients with atrial fibrillation: Results from the GARFIELD-AF, ORBIT-AF I, and ORBIT-AF II registries2017 · 220 citations