Insertable Cardiac Monitors Detect Previously Undiagnosed Atrial Fibrillation Interview with:
James A. Reiffel, M.D
Professor Emeritus of Medicine
Special Lecturer in Medicine
Dept of Medicine Cardiology
Columbia University Medical Center What is the background for this study? What are the main findings?

Response: Atrial fibrillation is a common arrhythmia (multi-millions of Americans) and carries with it a risk of stroke and of heart failure (among others) if not treated preventively. In many people, atrial fibrillation comes to attention because of symptoms, but not in all. The chances of developing Atrial fibrillation are substantially increased in certain populations of patients, such as the ones we enrolled in our study.  Continuous monitoring of such patients, as we did, and as others have also done recently, though in smaller numbers of patients, can detect otherwise unsuspected atrial fibrillation, which can lead to treatment before complications arise.

We found that using such monitoring, when monitored for 18 months, almost 1 in 3 patients had atrial fibrillation detected, as did 40% by 30 months. Intermittent monitoring, including by cell phones, may detect some atrial fibrillation but it is not nearly as effective as the type of monitoring we did and so many patients will be missed by lesser monitoring methods. What should clinicians and patients take away from your report?

Response: Atrial fibrillation is associated with an increased rate of death (in part from the associated disorders and from older age), of heart failure, of stroke and systemic embolism, of reduced quality of life due to symptoms, and more.  Treatment includes: control of the ventricular rate (the pulse) which during atrial fibrillation tends to be rapid; use of anticoagulants when atrial fibrillation is present in patients who have specific markers of increased risk of forming blood clots (including older age, hypertension, diabetes, heart failure, vascular disease, female gender, prior emboli); and reducing or preventing atrial fibrillation through specific antiarrhythmic drugs or catheter ablation procedures.  Rate-control to prevent the development of heart failure and anticoagulation in atrial fibrillation patients with high-risk markers should be considered in all patients with atrial fibrillation – in accordance with expert-developed guidelines (e.g., American Heart Association, American College of Cardiology, Heart Rhythm Society, European Society of Cardiology) – regardless of whether the patient has atrial fibrillation-associated symptoms.  Thus, to prevent such major morbidity/mortality risks, both symptomatic and asymptomatic (silent) atrial fibrillation needs to be recognized and addressed.

Accordingly, monitoring of patients with risk markers for atrial fibrillation can be life-saving.  Finally, the implantation of and follow up with monitoring devices, such as the one we are now using, has an incredibly low complication rate and high patient acceptance.  However, for it to reach its optimum utilization, more physicians and patients have to become aware of the concerns and the available approaches. What recommendations do you have for future research as a result of this study?

Response: Future research, already underway, is focusing on large-scale trials of anticoagulation in patients with device-detected “silent” atrial fibrillation.  The anticipation is that such studies will confirm that anticoagulation in these patients will reduce strokes and other emboli just as it does in patients with symptoms that led to atrial fibrillation detection, and in doing so will reduce the large burden of disability and death from embolic ischemic strokes due to atrial fibrillation (which have a 20% mortality rate). –What should be done to better detect atrial fibrillation in folks who have not yet been diagnosed?

Response: Educate general physicians as to the results of the type of study we did (ours and others like ours, such as the assert-2 and predate-atrial fibrillation studies). Thank you for your contribution to the community.


Incidence of Previously Undiagnosed Atrial Fibrillation Using Insertable Cardiac Monitors in a High-Risk Population The REVEAL ATRIAL FIBRILLATION Study

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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Last Updated on September 10, 2017 by Marie Benz MD FAAD