HOW to be sure not to miss any atrial

fibrillation ?

C.MARQUIE

I currently have, or have had over the last two years, an affiliation or financial

interests or interests of any order with a company or I receive compensation or

fees or research grants with a commercial company :

Grant/Research Support: Boston, Abbott, Livanova, Biotronik, Medtronic

Consulting Fees/Honoraria: Boston, Abbott, Livanova, Biotronik, Medtronic, Bayer, Zoll

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Royalty Income: none

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Other Financial Benefit: none

Disclosure Statement of Financial

Interest

AF epidemiology

In patients with stroke risk factors, atrial fibrillation

(AF) quintuples the risk of stroke

AF is associated with the risk of dementia, stroke, heart

failure, with an increase risk of cardiac and total mortality.

Hospitalization and QOL

Public health consequence

Cost

Up to 80% of AF are asymptomatic

Not missing AF means Reduction of stroke, FU after ablation, anticoagulation

treatment

Stroke 1991;22:983-988

AF epidemiology

Circulation 2006; 114:119-25

AF epidemiology

Tools of atrial detection

ECG: 30 seconds of AF

Telemetry

24-72 hours Holter-ECG recording

Pulse talking

Repet ECG

Systematic screening : undiagnosed AF was found in

1,4% of patients > 65 yo. 1

European Heart Journal (2016) 37, 2893–2962

1. Curr Opin Cardiol 2014;29:28-53

Tools of atrial detection

ECG: 30 seconds of AF

Telemetry

24-72 hours Holter-ECG recording

Pulse talking

Repet ECG

Systematic screening : undiagnosed AF was found in

1,4% of patients > 65 yo. 1

Recorders

« Pulse » Recorders

Courtesy C Kouakam

Recorders

EMBRACE

572 patients

> 55 y.o and cryptogenic ischemic stroke or TIA

Standard tests ( 24-hour ECG –monitoring)

30 day event-triggered recorder vs 24h holter

EP 1: First episod of AF ( 30 sec)

NEJM 2014;370:2467-77

EMBRACE

NEJM 2014;370:2467-77

Halcox JPJ et al. Circulation 2107; 136: 1784-94

2 groups RC vs Alivecor

1000 patients

30 sec single lead ECG

twice weekly

Halcox JPJ et al. Circulation 2107; 136: 1784-94

Halcox JPJ et al. Circulation 2107; 136: 1784-94

*iECG participants acquired iECGs twice weekly over 12 months (+ additional iECG if Σ)

MOBILE-AF

Treskes et al. Trials 2017;18:402

200 patients with cryptogenic stroke or TIA

First results in mid-2019

Tools of atrial detection

ECG: 30 seconds of AF

Telemetry

24-72 hours Holter-ECG recording

Pulse talking

Repet ECG

Systematic screening : undiagnosed AF was found in 1,4% of patients > 65 yo. 1

R-Test evolution

Recorders

Insertable cardiac monitor

Pacemaker or ICD

6894 hours of holter

VPN : 100%

Se : 100%

DETECT AF

JCE 2016;27:1403-10

Performance of ICM to detect AF ?

Ciconte. 2017

Performance of ICM to detect AF ?

Heart Rhythm 2016;13:1624-30

CRYSTAL-AF

441 patients

Cryptogenic stroke or TIA

Standart management 24 hours monitoring

IMC vs control

Sanna. N Engl J Med 2014;370:478-86

19 patients (8,9%) vs 3 (1,4%)

29 patients (12,4%) vs 4 (2%)

36 mois

42 patients (30%) vs 5 (3%)

Sanna. N Engl J Med 2014;370:478-86

STROKE-AF

Ongoing trial

prospective, multi-site, randomized,

controlled, open-label, post-market trial

500 patients

stroke attributed to large artery atherosclerosis

(cervical or intracranial),or small vessel disease (also

known as lacunar stroke)

IMC vs SOC

Am Heart J 2017;190:19-24

Pacemaker AND defibrillator

Pacemaker and defibrillator ASSERT study

Detection of atrial high rate episod

2580 patients PM or ICD

No prior AF

FU 2,5 years

Atrial high rate episod (> 6 min) are detected in

18,8% patients

NEJM 2012;366:120-9

European Heart Journal (2016) 37, 2893–2962

Conclusion

Many tools

Screening patients in routine pratice is faisible

It identifie a significant % of newly diagnosed AF

More you search… more you find…..

BUT more you search…

more you work…

and more we pay….

Interest ?

Thank you