Author + information
- Received April 5, 2017
- Revision received June 8, 2017
- Accepted June 15, 2017
- Published online December 18, 2017.
- Tine J. Philippsen, MDa,b,∗ (, )
- Lene S. Christensen, MD, PhDa,
- Michael G. Hansen, MDa,
- Jordi S. Dahl, MD, PhDb and
- Axel Brandes, MD, DMScb,c
- aDepartment of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark
- bDepartment of Cardiology, Odense University Hospital, Odense, Denmark
- cDepartment of Clinical Research, University of Southern Denmark, Odense, Denmark
- ↵∗Address for correspondence:
Dr. Tine J. Philippsen, Department of Cardiology, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark.
Objectives The study sought to determine the incidence of subclinical atrial fibrillation (AF) in high-risk patients and to compare the effect of continuous versus intermittent monitoring.
Background AF often occurs in a subclinical form, which makes it difficult to detect. The authors do not know the incidence of subclinical AF among patients ≥65 years of age with hypertension and diabetes mellitus. This group of patients has increased risk of developing AF and in addition a high thromboembolic risk, if AF is present.
Methods A total of 82 outpatients ≥65 years of age (median age 71.3 years [interquartile range [IQR]: 67.4 to 75.1 years]) with hypertension and diabetes mellitus, and no history of AF or any other cardiovascular disease, were consecutively included. All patients received an insertable cardiac monitor (ICM) and were followed for a median of 588 days (IQR: 453 to 712 days). We compared continuous monitoring with 72-h Holter monitoring 1 month after ICM insertion. The primary endpoint was AF ≥2 min for the ICM and AF ≥30 s for the Holter monitoring.
Results During follow-up 17 (20.7%) patients were found to have subclinical AF detected by ICM with a median time to first detected episode of 91 days (IQR: 41 to 251 days) from inclusion. Only 2 (2.4%) patients also had AF episodes on the 72-h Holter monitoring. All detected episodes were completely asymptomatic.
Conclusions The incidence of subclinical AF in this group of patients was surprisingly high. Continuous monitoring with ICM detected significantly more AF episodes than 72-h Holter monitoring. (Detection of Subclinical Atrial Fibrillation in High Risk Patients Using Implantable Loop Recorder; NCT02041832)
The study was funded by the University of Southern Denmark; Department of Cardiology, Hospital of Southern Jutland; Department of Cardiology, Odense University Hospital; A.P. Møller Foundation for the Advancement of Medical Science, Copenhagen, Denmark; Knud and Edith Eriksen’s Memorial Foundation, Sønderborg, Denmark; and Brødrene Hartmann’s Foundation, Copenhagen, Denmark. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 5, 2017.
- Revision received June 8, 2017.
- Accepted June 15, 2017.
- 2017 American College of Cardiology Foundation
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