Key result
Implantable loop recorders detect ~9-fold more subclinical AF than simulated 72-hour intermittent monitoring.
Why the study?
The effect of continuous versus intermittent rhythm monitoring to detect subclinical AF is poorly investigated in high-risk patients aged 65 years with hypertension and diabetes mellitus.
Cohort (n=82)
Answers are grounded in this paper and cite their sources.
Supports continuous over intermittent monitoring for subclinical AF detection; extends comparative evidence on monitoring duration.
Background: Atrial fibrillation (AF) often occurs in a subclinical form, which makes it difficult to detect.The effect of continuous versus intermittent rhythm monitoring to detect subclinical AF is poorly investigated in patients with age 65 years, hypertension and diabetes mellitus (DM).This group of patients has increased risk of developing AF and in addition a high thromboembolic risk, if AF is present.Purpose: To investigate whether continuous monitoring using an implantable loop recorder detects more episodes of subclinical AF than 72-hour intermittent monitoring in high-risk patients.Methods: A total of 82 outpatients 65 years of age (median age 71.3 years (IQR 67.4-75.1))with DM and hypertension, and no history of AF or any other cardiovascular disease, were consecutively included in this prospective study.None of the patients had prior symptoms of AF.All patients received an implantable loop recorder (ILR) and were followed for a median of 342 days (IQR 208-456).To compare continuous monitoring with 72hour intermittent monitoring, we simulated a 72-hour data collection by the device one month after ILR insertion.The primary end-point was AF with a minimum duration of two minutes.Oral anticoagulation treatment was initiated upon an AF episode lasting 6 minutes.Results: During follow-up 17 patients (20.7 %) were found to have subclinical AF detected by the ILR with a median time to first detected episode of 126 days (IQR 56-260) from inclusion.13 patients (15.9 %) had episodes of AF 6 minutes and initiated anticoagulant treatment.On the contrary, only 2 patients (2.4 %) also presented with AF episodes on the simulated 72-hour monitoring (p ¼ 0.04).All detected episodes were completely asymptomatic.Conclusions: Continuous monitoring with an implantable loop recorder detected significantly more AF episodes than 72-hour intermittent monitoring.The incidence of subclinical AF in this group of patients was surprisingly high.
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Philippsen et al. (2016) conducted a cohort in Subclinical atrial fibrillation in high-risk patients with diabetes mellitus and hypertension (n=82). Continuous rhythm monitoring using an implantable loop recorder (ILR) vs. Simulated 72-hour intermittent monitoring was evaluated on Atrial fibrillation with a minimum duration of two minutes (p=0.04). Continuous monitoring with an implantable loop recorder detected significantly more subclinical AF episodes than simulated 72-hour intermittent monitoring (20.7% vs 2.4%; p=0.04).
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