ESC Congress FA eBook 2016 - 23

ESC CONGRESS 2016

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IN REVIEW

FOCUS ON ARRHYTHMIAS

AF recurrence (89.5% vs 64.1%, CF vs non-CF; P = .04)
[Marijon E et al. J Cardiovasc Elecrophysiol. 2014]. In a
meta-analysis comparing CF with standard technology, CF technology showed a significant 37% reduction
(P = .01) in AF recurrence at a median follow-up of 12
months [Afzal MR et al. Heart Rhythm. 2015]. Whether
this technology improves outcomes in persistent AF is
yet to be proven.
In the presence of nonvalvular AF there is 4.5% risk
of ischemic stroke and > 7% risk of stroke/transient
ischemic attack (TIA)/silent cerebral infarcts. Giuseppe
Boriani, MD, PhD, University of Modena and Reggio
Emilia, Modena, Italy, discussed how implanted devices
can be used to detect AF-associated-stroke risk, as well
as aid in the clinical decision-making for anticoagulation
therapy.
Pacemaker-detected AF occurs in 50% of pacemaker patients and the rate of detection increases over
time [Healey JS et al. Can J Cardiol. 2013]. One study
has shown that implanted pacemakers with dedicated
functions for AF detection and electrogram storage can
maximize diagnostic capabilities for detecting silent AF
in more patients than ECGs [Israel CW et al. J Am Coll
Cardiol. 2004].
Long-term monitoring with implanted devices has
detected a significant amount of silent or subclinical AF
(defined as episodes of AF with a duration of minutes to
< 24 hours in patients without a clinical history of AF or
typical symptoms of AF). Implantable devices detect this
type of AF, as well as episodes of atrial high rate activity [Benezet-Mazuecos J et al. Europace. 2015]. In prior

studies, atrial high rate episodes have been associated
with a higher incidence of silent ischemic brain lesions,
but management recommendations are lacking.
The ANGELS of AF project demonstrated the data
obtained through continuous monitoring of the number and duration of AF episodes can be used to optimize
anticoagulation therapy (Figure 1) [Boriani G et al. Circ
Cardiovasc Qual Outcomes. 2012].
Ventricular tachycardia (VT) is associated with the
majority of the sudden cardiac deaths in the United
States [Compton SJ. Medscape 2015; http://emedicine.medscape.com/article/159075-overview; accessed
September 13, 2016]. Nikolaos Dagres, MD, University
Leipzig, Heart Center, Leipzig, Germany, discussed the
management of VT.
The most common cause of VT, structural heart disease, is also the most difficult to treat [Proclemer A et al.
Europace. 2013]. The 2015 guidelines from the European
Society of Cardiology guidelines [Priori SG et al. Eur
Heart J. 2015] recommend the use of implantable cardioverter defibrillators (ICD) in patients with VT, as they
are superior to antiarrhythmic therapy for increasing
overall survival [AVID Investigators. N Engl J Med. 1997].
However, ICDs are associated with shocks (appropriate
and inappropriate) that are associated with an increased
risk of mortality [Poole JE et al. N Engl J Med. 2008;
Guerra F et al. Europace. 2014].
This has led to a significant increase in ablations
worldwide [Gil-Ortega I et al. Rev Esp Cardiol (Engl
Ed). 2015]. Current ESC guidelines recommend urgent
catheter ablation in patients with scar-related disease

Percentage of Patients With Given Pharmacological Therapy, %

Figure 1. Continuous Monitoring of Atrial Fibrillation Episodes Improves Drug Therapy
100

Active intervention arm
Antiplatelet agents

90
80

Active intervention arm
Anticoagulation agents

Active intervention arm
Antiplatelet or
Anticoagulation agents

60
50

Control arm
Antiplatelet agents

40
30

Control arm
Anticoagulation agents

Control arm
Antiplatelet or
Anticoagulation agents

10
0

24
30
36
Observation Period, m

Reprinted from Boriani G et al. Improving Thromboprophylaxis Using Atrial Fibrillation Diagnostic Capabilities in Implantable Cardioverter-Defibrillators: The Multicentre Italian ANGELS
of AF Project. Circ Cardiovasc Qual Outcomes. 2012;5(2):182-8. By permission of Wolters Kluwer. Copyright © American Heart Association.

Official Peer-Reviewed Highlights From ESC Congress 2016

http://www.escardio.org/365 http://emedicine.medscape.com/article/159075-overview http://emedicine.medscape.com/article/159075-overview

Table of Contents for the Digital Edition of ESC Congress FA eBook 2016