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

Boriani, G; Healey, JS; Schnabel, RB; Lopes, RD; Calkins, H; Camm, JA; Freedman, B (2019) Oral anticoagulation for subclinical atrial tachyarrhythmias detected by implantable cardiac devices: an international survey of the AF-SCREEN Group. Int J Cardiol, 296. pp. 65-70. ISSN 1874-1754 https://doi.org/10.1016/j.ijcard.2019.07.039
SGUL Authors: Camm, Alan John

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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.

Item Type: Article
Additional Information: © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Anticoagulants, Atrial fibrillation, Cardiac implantable electronic devices, Stroke, Thromboembolism, Atrial fibrillation, Cardiac implantable electronic devices, Anticoagulants, Thromboembolism, Stroke, Anticoagulants, Atrial fibrillation, Cardiac implantable electronic devices, Stroke, Thromboembolism, 1102 Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Int J Cardiol
ISSN: 1874-1754
Language: eng
Dates:
DateEvent
1 December 2019Published
11 July 2019Published Online
10 July 2019Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
Projects:
Project IDFunderFunder ID
648131Horizon 2020UNSPECIFIED
BMBF 01ZX1408AGerman Ministry of Research and EducationUNSPECIFIED
81Z1710103German Center for Cardiovascular ResearchUNSPECIFIED
PubMed ID: 31327519
Web of Science ID: WOS:000488960200016
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111511
Publisher's version: https://doi.org/10.1016/j.ijcard.2019.07.039

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