doi: 10.1161/CIRCEP.109.909101
Editorial |
Everything Counts in Large Amounts
Device-Detected Atrial High-Rate Arrhythmias
From The Zena and Michael A. Wiener Cardiovascular Institute and The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Medical Center, New York, NY.
Correspondence to Jonathan L. Halperin, MD, The Zena and Michael A. Wiener Cardiovascular Institute, The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai Medical Center, Fifth Ave at 100th St, New York, NY 10029-6574. E-mail jonathan.halperin@mssm.edu
Key Words: atrial flutter • pacemakers • stroke • atrial fibrillation • implanted arrhythmia devices • Editorials
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Although the risk of stroke associated with paroxysmal atrial fibrillation (AF) is comparable to that with persistent (or permanent) AF, the lower representation of patients with paroxysmal AF in clinical trials reduces the confidence of the risk estimate.1 As a group, patients with paroxysmal AF are heterogeneous but typically younger, with less advanced associated cardiovascular disease than those with persistent or permanent AF. Episodes of AF occur daily in some patients but in others are separated by months or even years, and the duration of episodes varies considerably as well. Nevertheless, the threshold burden of paroxysmal AF required to justify chronic anticoagulant therapy has not been clearly defined, and prophylactic therapy is prescribed less consistently for patients with this form of the arrhythmia.2,3 Clinical practice guidelines currently recommend prophylactic antithrombotic therapy based on the axiom that paroxysmal and persistent AF carry similar risks of thromboembolism. The anticoagulation decision is based on clinical features other than the pattern, chronicity, or duration of AF, specifically the presence or absence of associated valvular heart disease, prior thromboembolism, advanced age, hypertension, diabetes, impaired left ventricular function, or heart failure.4
Article see p 474
Even in patients with symptomatic AF, asymptomatic episodes are common.3 In studies of unselected patients based on standard surface ECG recordings, the prevalence of asymptomatic AF ranged from 5% to 20%.5,6 Among the challenges in antithrombotic therapy is identifying patients with asymptomatic paroxysmal AF. Longer-term Holter and event monitoring increases the detection of asymptomatic AF, and in the Prevention of Atrial
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Circ Arrhythm Electrophysiol 2009 2: 474-480.