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December 1, 2015Open Access

Subclinical atrial tachyarrhythmias detected by implantable devices are associated with increased stroke risk, and while remote monitoring enables early detection, evidence for stroke reduction remains unclear.

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Why the study?

Does remote monitoring and device-detected atrial tachyarrhythmia management reduce ischemic stroke in patients with cardiac implantable electronic devices?

Population

Patients with cardiac implantable electronic devices (CIEDs) and external loop recorders

Comparison

Remote monitoring and device-based detection of… vs Standard clinical monitoring

Design

Review

Key result

Subclinical atrial tachyarrhythmias detected by implantable devices are associated with increased stroke risk, and while remote monitoring enables early detection, evidence for stroke reduction remains unclear.

Authors

EMElia De MariaIstituto RamazziniDGDaniele GiacopelliElectrophysiology

Discussion

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Member takes

Overview

Device-detected subclinical atrial tachyarrhythmias should not trigger anticoagulation; leaves open whether remote monitoring reduces stroke.

Structured PICO

Does remote monitoring and device-detected atrial tachyarrhythmia management reduce ischemic stroke in patients with cardiac implantable electronic devices?

P
Population
Patients with cardiac implantable electronic devices (CIEDs) and external loop recorders
I
Intervention
Remote monitoring and device-based detection of subclinical atrial tachyarrhythmias
C
Comparator
Standard clinical monitoring
O
Outcome
Ischemic stroke and systemic embolism

While CIEDs and remote monitoring effectively detect subclinical atrial tachyarrhythmias that correlate with stroke risk, the clinical benefit of initiating anticoagulation based solely on these device-detected episodes remains unproven.

Limitations

  • Lack of temporal relationship between device-detected atrial tachyarrhythmias and thromboembolic events
  • Uncertainties regarding the critical threshold for duration and burden of atrial high rate episodes to justify anticoagulation
  • Potential for false positive arrhythmia detection due to oversensing, far-field R wave detection, or repetitive non-re-entrant ventriculoatrial synchrony

Cite This Study

Maria et al. (2015) conducted a review in Subclinical Atrial Tachyarrhythmias and Cryptogenic Stroke. Cardiac implantable electronic devices and remote monitoring vs. Standard monitoring or conventional follow-up was evaluated. Subclinical atrial tachyarrhythmias detected by implantable devices are associated with increased stroke risk, and while remote monitoring enables early detection, evidence for stroke reduction remains unclear.

synapsesocial.com/papers/6a20abf2920e38fa09f9e348https://doi.org/10.4022/jafib.1249
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Also Consider

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

  1. 1Subclinical Atrial Fibrillation and Anticoagulation: Weighing the Absolute Risks and Benefits2024 · 13 citations
  2. 2Device-Detected Atrial Fibrillation2015 · 55 citations
  3. 3Atrial fibrillation monitoring to reduce thromboembolic risk: Selecting the patient and the monitoring device2017
  4. 4Atrial fibrillation monitoring to reduce thromboembolic risk: Selecting the patient and the monitoring device2017
  5. 5The Role of Cardiovascular Implantable Electronic Devices in the Detection and Treatment of Subclinical Atrial Fibrillation2017 · 31 citations