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Int J Cardiol. 2019 Dec 1;296:65-70. doi: 10.1016/j.ijcard.2019.07.039. Epub 2019 Jul 11.

Oral anticoagulation for subclinical atrial tachyarrhythmias detected by implantable cardiac devices: an international survey of the AF-SCREEN Group.

Author information

1
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; AF-SCREEN International Collaboration. Electronic address: giuseppe.boriani@unimore.it.
2
AF-SCREEN International Collaboration; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
3
AF-SCREEN International Collaboration; University Heart Center Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
4
AF-SCREEN International Collaboration; Duke University Medical Center, Durham, NC, USA.
5
AF-SCREEN International Collaboration; Cardiology Division, Johns Hopkins University, Baltimore, MD, USA.
6
AF-SCREEN International Collaboration; St George's University of London, London, UK.
7
AF-SCREEN International Collaboration; Heart Research Institute, Charles Perkins Centre, Concord Hospital Cardiology, University of Sydney, Sydney, Australia.

Abstract

AIMS:

At present, there is little evidence on how to treat subclinical atrial fibrillation (SCAF) or atrial high rate episodes (AHREs) detected by cardiac implantable electronic devices (CIEDs). Our aim was to assess current practice around oral anticoagulation (OAC) in such patients.

METHODS:

A web-based survey undertaken by 310 physicians: 59 AF-SCREEN International Collaboration members and 251 non-members.

RESULTS:

In patients with SCAF/AHRE and a CHA2DS2VASc ≥ 2 in males or ≥ 3 in female the amount of SCAF/AHRE triggering use of OAC was variable but <2% of respondents considered that no AHRE would require OAC. Around one third (34%) considered SCAF/AHRE duration of >5-6 min as the basis for OAC prescription, while 16% and 18% required a burden of at least 5.5 h or 24 h, respectively. The propensity to prescribe OAC for a low burden of AHREs differed according to certain respondent characteristics (greater propensity to prescribe OAC for neurologists). When the clinical scenario included a prior stroke or a prior cardioembolic stroke, stated prescription of OAC was very high. More than 96% felt that any SCAF/AHRE should be treated with OAC.

CONCLUSIONS:

There is substantial heterogeneity in the perception of the risk of stroke/systemic embolism associated with SCAF/AHRE of variable duration. The threshold of AHRE burden that would trigger initiation of OAC is highly variable, and differs according to the clinical scenario (lower threshold in case of previous stroke). Ongoing trials will clarify the real benefit and risk/benefit ratio of OAC in this specific clinical setting.

KEYWORDS:

Anticoagulants; Atrial fibrillation; Cardiac implantable electronic devices; Stroke; Thromboembolism

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