Remote monitoring from implantation detects AF in 20% of CIED patients at 77 days: a call for precision prevention
E Kandic, I Zdravkovski, F Janushevski, D Cvetkovski, L Poposka, J TaleskiAbstract
Introduction
Subclinical atrial fibrillation (SCAF) defined by atrial high rate episodes (AHRE) in patients with cardiac implantable electronic devices (CIEDs) can determine the clinical AF and the stroke risk. Remote monitoring (RM) enables continuous atrial surveillance from the implantation, potentially detecting SCAF earlier than standard care.
Aims
To assess incidence and early detection of atrial fibrillation (AF) via remote monitoring (RM) from implantation in CIED patients.
Methods
This is a single center retrospective study of 80 CIED patients (ICD/CRT-P/CRT-D) with RM activated at implant and ≥12 months follow-up. Atrial high-rate episodes (AHRE) defined as atrial rate >180 bpm for >6 minutes. RM data included AHRE count, first episode date, and burden (% time in AF). Time to detection was calculated from implantation. Intracardiac electrograms (IEGMs) validated all subclinical AF cases. Clinical data were retrieved from electronic health records.
Results
AF detected in 16/80 (20%). Median time to first AF: 77days (IQR 42–186). Median AHRE count: 25 (IQR 6–88), mean burden in AF+ patients: 8.4% ± 12.1% (median 3.2%).RM transmission success 94%. In this patient group, mean age was 62 ± 11 yrs, 69% were male, median LVEF 42% and mean CHA2DS2-VASc was 3. In all 16 cases, subclinical AF was confirmed by IEGM. From MACCE no strokes were noted.
Conclusions
Remote monitoring uncovers AF in 1 in 5 CIEDs patients at just 77 days after implantation, which proves RM as the new standard for early stroke prevention.