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

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:296

Article

Boriani, Giuseppe^1,2  Healey, Jeff S.^2,3  Schnabel, Renate B.^2,4,5  Lopes, Renato D.^2,6  Calkins, Hugh^2,7  Camm, John A.^2,8  Freedman, Ben^2,9 

[1] Univ Modena & Reggio Emilia, Policlin Modena, Dept Biomed Metab & Neural Sci, Cardiol Div, Via Pozzo 71, I-41124 Modena, Italy

[2] AF SCREEN Int Collaborat, Venice, Italy

[3] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada

[4] Univ Heart Ctr Hamburg, Hamburg, Germany

[5] German Ctr Cardiovasc Res, Partner Site Hamburg Kiel Luebeck, Hamburg, Germany

[6] Duke Univ, Med Ctr, Durham, NC USA

[7] Johns Hopkins Univ, Cardiol Div, Baltimore, MD USA

[8] St Georges Univ London, London, England

[9] Univ Sydney, Concord Hosp Cardiol, Charles Perkins Ctr, Heart Res Inst, Sydney, NSW, Australia

关键词: Atrial fibrillation;    Cardiac implantable electronic devices;    Anticoagulants;    Thromboembolism;    Stroke;   

DOI  :  10.1016/j.ijcard.2019.07.039

来源: Elsevier

【 摘 要 】

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 CHA(2)DS(2)VASc >= 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. (C) 2019 Elsevier B.V. All rights reserved.

【 授权许可】

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