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August 26, 2017JAMA Cardiology

Incidence of Previously Undiagnosed Atrial Fibrillation Using Insertable Cardiac Monitors in a High-Risk Population

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Key result

Monitoring with an insertable cardiac monitor detected previously undiagnosed atrial fibrillation lasting 6 or more minutes in 29.3% of high-risk patients at 18 months.

Population

446 patients at high risk for but without previously known atrial fibrillation, mean age 71.5, 52.2% male…

Design

Cohort, open-label

Follow-up

mean 22.5 months (range 18 to 30 months)

Authors

JRJames A. ReiffelAVAtul VermaPKPeter R. Kowey

Discussion

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Overview

High AF detection rates frequently prompt oral anticoagulation initiation; leaves open whether this intensive screening strategy ultimately reduces.

Study Design

Type

Cohort (n=446)

Blinding

Open-label

Multicenter

Yes

Structured PICO

P
Population
446 patients at high risk for atrial fibrillation and stroke without previously known atrial fibrillation, monitored with an insertable cardiac monitor for 18 to 30 months.
I
Intervention
Insertable cardiac monitor (Reveal XT or Reveal LINQ) with continuous monitoring for 18 to 30 months.
O
Outcome
Incidence of adjudicated atrial fibrillation lasting 6 or more minutes at 18 months.

In patients at high risk for stroke but without known atrial fibrillation, continuous monitoring with an insertable cardiac monitor detected previously undiagnosed AF in nearly 30% of patients at 18 months, frequently leading to the initiation of oral anticoagulation.

Limitations

  • Modest sample size
  • Unable to assess the embolic risk posed by device-detected AF because of the small number of strokes
  • Positive predictive value of ICMs for AF depends on episode duration, device settings, and AF incidence
  • Low enrollment rate and premature dropouts make it difficult to determine external validity
  • Analysis of circulating biomarkers as predictors of AF was underpowered

Cite This Study

Reiffel et al. (2017) conducted a cohort in High risk for atrial fibrillation (n=446). Insertable cardiac monitor was evaluated on Adjudicated atrial fibrillation lasting 6 or more minutes at 18 months (95% CI 24.4-33.8). Monitoring with an insertable cardiac monitor detected previously undiagnosed atrial fibrillation lasting 6 or more minutes in 29.3% of high-risk patients at 18 months.

synapsesocial.com/papers/6a81893bf34fcd4e77775d8dhttps://doi.org/10.1001/jamacardio.2017.3180
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Also Consider

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

  1. 1Screening to identify unknown atrial fibrillation. A systematic review.2013 · 191 citations
  2. 2Monitored Atrial Fibrillation Duration Predicts Arterial Embolic Events in Patients Suffering From Bradycardia and Atrial Fibrillation Implanted With Antitachycardia Pacemakers2005 · 403 citations
  3. 3Atrial Fibrillation Burden Estimates Derived from Intermittent Rhythm Monitoring are Unreliable Estimates of the True Atrial Fibrillation Burden2014 · 43 citations
  4. 4Cryptogenic Stroke and Underlying Atrial Fibrillation2014 · 2,175 citations
  5. 5Atrial High Rate Episodes Detected by Pacemaker Diagnostics Predict Death and Stroke2003 · 759 citations