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Maria E, Giacopelli D. Subclinical Atrial Tachyarrhythmias:Implantable Devices and Remote Monitoring. J Atr Fibrillation. 2015;8(4):1249doi: 10.4022/jafib.1249.
Maria, E., & Giacopelli, D. (2015). Subclinical Atrial Tachyarrhythmias:Implantable Devices and Remote Monitoring. Journal of atrial fibrillation, 8(4), 1249. https://doi.org/10.4022/jafib.1249
Maria, Elia De, and Giacopelli, Daniele. "Subclinical Atrial Tachyarrhythmias:Implantable Devices and Remote Monitoring." Journal of atrial fibrillation vol. 8,4 (2015): 1249. doi: https://doi.org/10.4022/jafib.1249
Maria E, Giacopelli D. Subclinical Atrial Tachyarrhythmias:Implantable Devices and Remote Monitoring. J Atr Fibrillation. 2015 Dec 31;8(4):1249. doi: 10.4022/jafib.1249. eCollection 2015 Dec. PMID: 27957222; PMCID: PMC5135181.
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J Atr Fibrillation. 2015 Dec 31;8(4):1249. doi: 10.4022/jafib.1249. eCollection 2015 Dec.

Subclinical Atrial Tachyarrhythmias:Implantable Devices and Remote Monitoring.

Journal of atrial fibrillation

Elia De Maria, Daniele Giacopelli

Affiliations

  1. Arrhythmology Cath Lab, Cardiology Unit, Ramazzini Hospital, Via Molinari 1, 41012, Carpi (Modena), Italy.
  2. Biotronik Italia, Via Delle Industrie 11, 20090 Vimodrone (Milano), Italy.

PMID: 27957222 PMCID: PMC5135181 DOI: 10.4022/jafib.1249

Abstract

Atrial fibrillation (AF) and Atrial Tachyarrhythmias (AT) are the most common clinical arrhythmias and their worst issue is a well-recognized correlation with ischemic stroke. High incidence of "subclinical" AF/ATs has been demonstrated in several trials (TRENDS, ASSERT, CRYSTAL AF, EMBRACE) in patients with both cardiac implantable electronic devices (CIEDS) and external loop recorders. Moreover, a relationship between device-detected AF/ATs and stroke risk has been observed in the same studies. However, while the net clinical benefit of the antithrombotic treatment is well established in patients with "clinical" atrial fibrillation, there may be a lower benefit in patients with device-detected arrhythmias. Subclinical AF/ATs may be considered as a marker of stroke risk rather than the proximate cause and their burden may be used in combination with CHA2DS2-VASC and HAS-BLED scores to identify high-risk population who deserves anticoagulation. Today the remote monitoring associated with the CIEDs is effective in the early detecting of AF/ATs by avoiding delays in the therapy evaluation, as demonstrated by several trials (TRUST, CONNECT, COMPAS). However clinical evidence for stroke risk reduction by remote monitoring is still awaited; the recent trial IMPACT failed to demonstrate that the handling of the anticoagulation therapy guided by device-detected ATs and remote monitoring improves the patients' outcome. The challenges for clinicians are to deal with the huge data entry, to define new organizational models, to improve device patient management and to continuously update AF guidelines in according to the great amount of data offered by the new technology.

Keywords: Atrial Fibrillation; Atrial Tachyarrhytmias; Cardiac Implantable Electronic Devices; Cryptogenic Stroke; Remote Monitoring

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