Conclusion Patients with an AHRE burden over 6 min have an increased risk for stroke .
Aims Atrial fibrillation ( AF ) patients have increased risk of stroke .
In paroxysmal AF , the combination of duration and frequency of episodes defines AF burden .
In patients with cardiac implantable electronic devices ( CIEDs ) , atrial high-rate episodes ( AHREs ) can be monitored continuously and are considered as a proxy for AF .
This systematic review aims to determine the relationship between AF burden and risk of thrombo-embolic events ( TBEs ) .
Incidence of Previously Undiagnosed Atrial Fibrillation Using Insertable Cardiac Monitors in a High-Risk Population: The REVEAL AF Study
Importance In approximately 20 % of atrial fibrillation (AF)–related ischemic strokes , stroke is the first clinical manifestation of AF . Strategies are needed to identify and therapeutically address previously undetected AF . Objective To quantify the incidence of AF in patients at high risk for but without previously known AF using an insertable cardiac monitor .  Design , Setting , and Participants This prospect i ve , single-arm , multicenter study was conducted from November 2012 to January 2017 . Visits took place at 57 centers in the United States and Europe . Patients with a CHADS2 score of 3 or greater ( or 2 with at least 1 additional risk factor ) were enrolled . Approximately 90 % had nonspecific symptoms potentially compatible with AF , such as fatigue , dyspnea , and /or palpitations . Exposures Patients underwent monitoring with an insertable cardiac monitor for 18 to 30 months . Main Outcomes and Measures The primary end point was adjudicated AF lasting 6 or more minutes and was assessed at 18 months . Other analyses included detection rates at points from 30 days to 30 months and among CHADS2 score subgroups . Median time from insertion to detection and the percentage of patients subsequently prescribed oral anticoagulation therapy was also determined . Results A total of 446 patients were enrolled ; 233 ( 52.2 % ) were male , and the mean ( SD ) age was 71.5 ( 9.9 ) years . A total of 385 patients ( 86.3 % ) received an insertable cardiac monitor , met the primary analysis cohort definition , and were observed for a mean ( SD ) period of 22.5 ( 7.7 ) months . The detection rate of AF lasting 6 or more minutes at 18 months was 29.3 % . Detection rates at 30 days and 6 , 12 , 24 , and 30 months were 6.2 % , 20.4 % , 27.1 % , 33.6 % , and 40.0 % , respectively . At 18 months , AF incidence was similar among patients with CHADS2 scores of 2 ( 24.7 % ; 95 % CI , 17.3 - 31.4 ) , 3 ( 32.7 % ; 95 % CI , 23.8 - 40.7 ) , and 4 or greater ( 31.7 % ; 95 % CI , 22.0 - 40.3 ) ( P = .23 ) . Median ( interquartile ) time from device insertion to first AF episode detection was 123 ( 41 - 330 ) days . Of patients meeting the primary end point , 13 ( 10.2 % ) had 1 or more episodes lasting 24 hours or longer , and oral anticoagulation therapy was prescribed for 72 patients ( 56.3 % ) . Conclusions and Relevance The incidence of previously undiagnosed AF may be substantial in patients with risk factors for AF and stroke . Atrial fibrillation would have gone undetected in most patients had monitoring been limited to 30 days . Further trials regarding the value of detecting sub clinical AF and of prophylactic therapies are warranted . Trial Registration clinical trials.gov Identifier :
Conclusion Patients with an AHRE burden over 6 min have an increased risk for stroke .
Aims Atrial fibrillation ( AF ) patients have increased risk of stroke .
In paroxysmal AF , the combination of duration and frequency of episodes defines AF burden .
In patients with cardiac implantable electronic devices ( CIEDs ) , atrial high-rate episodes ( AHREs ) can be monitored continuously and are considered as a proxy for AF .
This systematic review aims to determine the relationship between AF burden and risk of thrombo-embolic events ( TBEs ) .