Associations Between Changes in Maximum Daily Atrial Fibrillation Duration, Ischemic Stroke and Mortality (JCEP November 2024)-Article: Associations Between Changes in Maximum Daily Atrial Fibrillation Duration, Ischemic Stroke and Mortality

Article: Associations Between Changes in Maximum Daily Atrial Fibrillation Duration, Ischemic Stroke and Mortality

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A study explored the relationship between changes in maximum daily atrial fibrillation duration (MDAFD) and the risks of ischemic stroke and mortality in patients with cardiac implantable electronic devices (CIEDs). Conducted with data from 26,400 patients, researchers from Northwestern University and Medtronic sought to determine how variations in atrial fibrillation (AF) burden correlate with health outcomes.<br /><br />The analysis revealed that increased MDAFD was linked to a higher risk of stroke and death compared to stable AF duration. Specifically, patients whose AF burden increased over time showed higher rates of stroke and mortality, underscoring the critical risk AF poses even when considered in continuous measures rather than a binary state.<br /><br />Among individuals with no AF at baseline, the development of AF later significantly raised the risk of adverse outcomes. Interestingly, reducing the AF burden in patients who initially had substantial AF duration (1 to 23.5 hours daily) was associated with decreased risk, suggesting potential benefits from interventions aimed at AF control.<br /><br />Only patients without oral anticoagulation were included to isolate the effects of AF burden changes on health outcomes. The insights gained stress that AF burden is dynamic, fluctuating with natural physiological changes or interventional treatments, emphasizing the necessity of regular monitoring.<br /><br />The results align with previous studies but advance knowledge by highlighting that any baseline AF is associated with stroke and mortality, with durations over 5.5 hours posing specific stroke risk. These findings are particularly valuable for advancing risk stratification and treatment approaches for AF, potentially advocating for rhythm-control strategies.<br /><br />The study’s retrospective nature limits firm causal conclusions, and the exclusive focus on CIED patients without anticoagulation suggests the need for broader population studies. Nonetheless, it advocates that monitoring and controlling AF over time could positively impact patient outcomes.

Keywords

atrial fibrillation

ischemic stroke

mortality

cardiac implantable electronic devices

AF burden

Northwestern University

Medtronic

stroke risk

AF control

risk stratification