Subclinical Atrial Tachyarrhythmias: Implantable Devices and Remote Monitoring

摘要

800x600 Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} Atrial fibrillation (AF) and Atrial Tachyarrhythmias (AT) are the most common clinical arrhythmias and their worst issue is a well-recognized correlation with ischemic stroke. Their detection results difficult by using the traditional monitoring techniques due to their often paroxysmal and asymptomatic nature. They may be unmasked only with a more aggressive monitoring technique. Pacemakers and implantable cardioverter defibrillators should be seen not only as therapeutic devices but also as diagnostic tools that can prevent serious adverse events, particularly thromboembolic ones. Moreover, the need of implanted cardiac devices whose sole purpose would be to detect previously undiagnosed arrhythmias, such as AF/AT, is nowadays taken into account by the Guidelines recommendations. This may lead to a more patient-centered approach where each individual can tailor the use of anticoagulants through consideration of the presence and duration of AF episodes, in addition to clinical risk scores. These data become meaningful if they are early available: today this is possible thanks to the daily remote monitoring of the devices. Effectiveness of remote monitoring in early detecting and treating atrial fibrillation, as well as in monitoring therapy effects and patient clinical status, has been demonstrated. However, the clinical evidence for stroke risk reduction by remote monitoring is still awaited. This new available technology needs a new organizational model to improve device and patient management and optimize resource utilization.