Everything counts in large amounts: device-detected atrial high-rate arrhythmias.

摘要

Although the risk of stroke associated with paroxysmal atrial fibrillation (AF) is comparable to that with persistent (or permanent) AF, the lower representation of patients with paroxysmal AF in clinical trials reduces the confidence of the risk estimate.1 As a group, patients with paroxysmal AF are heterogeneous but typically younger, with less advanced associated cardiovascular disease than those with persistent or permanent AF. Episodes of AF occur daily in some patients but in others are separated by months or even years, and the duration of episodes varies considerably as well. Nevertheless, the threshold burden of paroxysmal AF required to justify chronic anticoagulant therapy has not been clearly defined, and prophylactic therapy is prescribed less consistently for patients with this form of the arrhythmia.2-3 Clinical practice guidelines currently recommend prophylactic antithrombotic therapy based on the axiom that paroxysmal and persistent AF carry similar risks of thromboembo-lism. The anticoagulation decision is based on clinical features other than the pattern, chronicity, or duration of AF, specifically the presence or absence of associated valvular heart disease, prior thromboembolism, advanced age, hypertension, diabetes, impaired left ventricular function, or heart failure.