Elsevier

Heart Rhythm

Volume 8, Issue 9, September 2011, Pages 1424-1425
Heart Rhythm

Focus issue: Atrial fibrillation: Clinical
Device: Editorial commentary
Atrial fibrillation and stroke: It's not necessarily all about the rhythm

https://doi.org/10.1016/j.hrthm.2011.05.005Get rights and content

Section snippets

Device-detected atrial tachycardia (AT)/AF burden and stroke

Timely diagnosis of AF is often challenging because it is frequently asymptomatic.3 Implantable device-based monitoring has been shown to reliably diagnose AF and rapid ATs with superior sensitivity and specificity compared with intermittent external monitoring.4 Although the risk of stroke or systemic emboli (SSE) is comparable in paroxysmal and persistent AF5, the risk of SSE associated with brief AT/AF episodes is less well established.

Evidence emerging from prospective studies suggests that

Etiology of stroke in patients with AF

To date, the available evidence suggests that the majority of AF-related strokes are due to thromboemboli originating from the left atrial appendage.10 Given the absence of a clear temporal relationship between AT/AF episodes in the majority of SSE events, what do the TRENDS data tell us about the mechanisms behind AF-related stroke? First, it is important to note that TRENDS included patients without a prior history of AF. In fact, 20% of the substudy cohort did not have a diagnosis of AF at

Clinical implications

Despite current guideline recommendations that advise against basing stroke prevention treatment decisions on type of AF, clinicians continue to do so.5 Although AT/AF burden does appear to be associated with increased stroke risk, AT/AF arrhythmias will not necessarily or reliably precede and predict SSE. Additionally, attempts to integrate AF burden into risk stratification schemes have improved specificity, but fail to improve sensitivity of more comprehensive measures such as CHA2DS2-VASc.16

References (18)

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J.P.P. receives research funding from Boston Scientific, Johnson & Johnson, and Bayer Healthcare. J.P.D. received research support from Boston Scientific, St. Jude, Medtronic, Biosense-Webster; institutional fellowship support from Boston Scientific, St. Jude, Medtronic, Biosense-Webster, and Bard; and honoraria for advisory board participation or lectures from Biosense-Webster, Sanofi-Aventis, Boston Scientific, and Sorin Medical.

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