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Review article: Biomedical intelligence

Vol. 147 No. 2526 (2017)

The search for atrial fibrillation and its impact on public health

  • Anna Lam
  • Eleni Goulouti
  • Laurent Roten
DOI
https://doi.org/10.4414/smw.2017.14447
Cite this as:
Swiss Med Wkly. 2017;147:w14447
Published
30.06.2017

Summary

Atrial fibrillation may be clearly symptomatic and is easily amenable to state-of-the-art treatment, most importantly oral anticoagulation therapy for the prevention of thromboembolism. However, atrial fibrillation may also go unnoticed for long periods in many patients. This silent or subclinical atrial fibrillation is nevertheless associated with thromboembolic risk just like clinically evident atrial fibrillation. Early detection of atrial fibrillation in patients at increased thromboembolic risk and consequent oral anticoagulation therapy may have a significant impact on public health. This review focuses on screening recommendations for atrial fibrillation and on the impact of silent atrial fibrillation in various clinical scenarios.

References

  1. Heeringa J, van der Kuip DA, Hofman A, Kors JA, van Herpen G, Stricker BH, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J. 2006;27(8):949–53. https://doi.org/10.1093/eurheartj/ehi825
  2. Naccarelli GV, Varker H, Lin J, Schulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol. 2009;104(11):1534–9. https://doi.org/10.1016/j.amjcard.2009.07.022
  3. Buchwald F, Norrving B, Petersson J. Atrial Fibrillation in Transient Ischemic Attack Versus Ischemic Stroke: A Swedish Stroke Register (Riksstroke) Study. Stroke. 2016;47(10):2456–61. https://doi.org/10.1161/STROKEAHA.116.013988
  4. Stewart S, Hart CL, Hole DJ, McMurray JJ. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med. 2002;113(5):359–64. https://doi.org/10.1016/S0002-9343(02)01236-6
  5. Kalantarian S, Ay H, Gollub RL, Lee H, Retzepi K, Mansour M, et al. Association between atrial fibrillation and silent cerebral infarctions: a systematic review and meta-analysis. Ann Intern Med. 2014;161(9):650–8. https://doi.org/10.7326/M14-0538
  6. Santangeli P, Di Biase L, Bai R, Mohanty S, Pump A, Cereceda Brantes M, et al. Atrial fibrillation and the risk of incident dementia: a meta-analysis. Heart Rhythm. 2012;9(11):1761–8. https://doi.org/10.1016/j.hrthm.2012.07.026
  7. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893–962. https://doi.org/10.1093/eurheartj/ehw210
  8. McGrath ER, Kapral MK, Fang J, Eikelboom JW, Conghaile A, Canavan M, et al., Investigators of the Ontario Stroke Registry. Association of atrial fibrillation with mortality and disability after ischemic stroke. Neurology. 2013;81(9):825–32. https://doi.org/10.1212/WNL.0b013e3182a2cc15
  9. Sposato LA, Cipriano LE, Saposnik G, Ruíz Vargas E, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2015;14(4):377–87. https://doi.org/10.1016/S1474-4422(15)70027-X
  10. Lowres N, Neubeck L, Redfern J, Freedman SB. Screening to identify unknown atrial fibrillation. A systematic review. Thromb Haemost. 2013;110(2):213–22. https://doi.org/10.1160/TH13-02-0165
  11. Engdahl J, Andersson L, Mirskaya M, Rosenqvist M. Stepwise screening of atrial fibrillation in a 75-year-old population: implications for stroke prevention. Circulation. 2013;127(8):930–7. https://doi.org/10.1161/CIRCULATIONAHA.112.126656
  12. Svennberg E, Engdahl J, Al-Khalili F, Friberg L, Frykman V, Rosenqvist M. Mass Screening for Untreated Atrial Fibrillation: The STROKESTOP Study. Circulation. 2015;131(25):2176–84. https://doi.org/10.1161/CIRCULATIONAHA.114.014343
  13. Stahrenberg R, Edelmann F, Haase B, Lahno R, Seegers J, Weber-Krüger M, et al. Transthoracic echocardiography to rule out paroxysmal atrial fibrillation as a cause of stroke or transient ischemic attack. Stroke. 2011;42(12):3643–5. https://doi.org/10.1161/STROKEAHA.111.632836
  14. De Vos CB, Weijs B, Crijns HJ, Cheriex EC, Palmans A, Habets J, et al. Atrial tissue Doppler imaging for prediction of new-onset atrial fibrillation. Heart. 2009;95(10):835–40. https://doi.org/10.1136/hrt.2008.148528
  15. Peña JM, MacFadyen J, Glynn RJ, Ridker PM. High-sensitivity C-reactive protein, statin therapy, and risks of atrial fibrillation: an exploratory analysis of the JUPITER trial. Eur Heart J. 2012;33(4):531–7. https://doi.org/10.1093/eurheartj/ehr460
  16. Dewland TA, Vittinghoff E, Mandyam MC, Heckbert SR, Siscovick DS, Stein PK, et al. Atrial ectopy as a predictor of incident atrial fibrillation: a cohort study. Ann Intern Med. 2013;159(11):721–8. https://doi.org/10.7326/0003-4819-159-11-201312030-00004
  17. Beaulieu-Boire I, Leblanc N, Berger L, Boulanger JM. Troponin elevation predicts atrial fibrillation in patients with stroke or transient ischemic attack. J Stroke Cerebrovasc Dis. 2013;22(7):978–83. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.01.008
  18. Shibazaki K, Kimura K, Fujii S, Sakai K, Iguchi Y. Brain natriuretic peptide levels as a predictor for new atrial fibrillation during hospitalization in patients with acute ischemic stroke. Am J Cardiol. 2012;109(9):1303–7. https://doi.org/10.1016/j.amjcard.2011.12.022
  19. Wallmann D, Tüller D, Kucher N, Fuhrer J, Arnold M, Delacretaz E. Frequent atrial premature contractions as a surrogate marker for paroxysmal atrial fibrillation in patients with acute ischaemic stroke. Heart. 2003;89(10):1247–8. https://doi.org/10.1136/heart.89.10.1247
  20. Friberg L, Engdahl J, Frykman V, Svennberg E, Levin LA, Rosenqvist M. Population screening of 75- and 76-year-old men and women for silent atrial fibrillation (STROKESTOP). Europace. 2013;15(1):135–40. https://doi.org/10.1093/europace/eus217
  21. Hylek EM, Go AS, Chang Y, Jensvold NG, Henault LE, Selby JV, et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med. 2003;349(11):1019–26. https://doi.org/10.1056/NEJMoa022913
  22. Gladstone DJ, Spring M, Dorian P, Panzov V, Thorpe KE, Hall J, et al.; EMBRACE Investigators and Coordinators. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med. 2014;370(26):2467–77. https://doi.org/10.1056/NEJMoa1311376
  23. Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, et al.; CRYSTAL AF Investigators. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014;370(26):2478–86. https://doi.org/10.1056/NEJMoa1313600
  24. Grond M, Jauss M, Hamann G, Stark E, Veltkamp R, Nabavi D, et al. Improved detection of silent atrial fibrillation using 72-hour Holter ECG in patients with ischemic stroke: a prospective multicenter cohort study. Stroke. 2013;44(12):3357–64. https://doi.org/10.1161/STROKEAHA.113.001884
  25. Fanning JP, Wong AA, Fraser JF. The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Med. 2014;12(1):119. https://doi.org/10.1186/s12916-014-0119-0
  26. Vermeer SE, Koudstaal PJ, Oudkerk M, Hofman A, Breteler MM. Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke. 2002;33(1):21–5. https://doi.org/10.1161/hs0102.101629
  27. Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003;348(13):1215–22. https://doi.org/10.1056/NEJMoa022066
  28. Gupta A, Giambrone AE, Gialdini G, Finn C, Delgado D, Gutierrez J, et al. Silent Brain Infarction and Risk of Future Stroke: A Systematic Review and Meta-Analysis. Stroke. 2016;47(3):719–25.
  29. Glotzer TV, Hellkamp AS, Zimmerman J, Sweeney MO, Yee R, Marinchak R, et al.; MOST Investigators. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST). Circulation. 2003;107(12):1614–9. https://doi.org/10.1161/01.CIR.0000057981.70380.45
  30. Healey JS, Connolly SJ, Gold MR, Israel CW, Van Gelder IC, Capucci A, et al.; ASSERT Investigators. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012;366(2):120–9. https://doi.org/10.1056/NEJMoa1105575
  31. Glotzer TV, Daoud EG, Wyse DG, Singer DE, Ezekowitz MD, Hilker C, et al. The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk: the TRENDS study. Circ Arrhythm Electrophysiol. 2009;2(5):474–80. https://doi.org/10.1161/CIRCEP.109.849638
  32. Benezet-Mazuecos J, Rubio JM, Cortés M, Iglesias JA, Calle S, de la Vieja JJ, et al. Silent ischaemic brain lesions related to atrial high rate episodes in patients with cardiac implantable electronic devices. Europace. 2015;17(3):364–9. https://doi.org/10.1093/europace/euu267
  33. Brambatti M, Connolly SJ, Gold MR, Morillo CA, Capucci A, Muto C, et al.; ASSERT Investigators. Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation. 2014;129(21):2094–9. https://doi.org/10.1161/CIRCULATIONAHA.113.007825
  34. Daoud EG, Glotzer TV, Wyse DG, Ezekowitz MD, Hilker C, Koehler J, et al.; TRENDS Investigators. Temporal relationship of atrial tachyarrhythmias, cerebrovascular events, and systemic emboli based on stored device data: a subgroup analysis of TRENDS. Heart Rhythm. 2011;8(9):1416–23. https://doi.org/10.1016/j.hrthm.2011.04.022
  35. Mitchell LB, Southern DA, Galbraith D, Ghali WA, Knudtson M, Wilton SB ; APPROACH investigators. Prediction of stroke or TIA in patients without atrial fibrillation using CHADS2 and CHA2DS2-VASc scores. Heart. 2014;100(19):1524–30. https://doi.org/10.1136/heartjnl-2013-305303
  36. Welles CC, Whooley MA, Na B, Ganz P, Schiller NB, Turakhia MP. The CHADS2 score predicts ischemic stroke in the absence of atrial fibrillation among subjects with coronary heart disease: data from the Heart and Soul Study. Am Heart J. 2011;162(3):555–61. https://doi.org/10.1016/j.ahj.2011.05.023
  37. Ntaios G, Lip GY, Makaritsis K, Papavasileiou V, Vemmou A, Koroboki E, et al. CHADS2, CHA2S2DS2-VASc, and long-term stroke outcome in patients without atrial fibrillation. Neurology. 2013;80(11):1009–17. https://doi.org/10.1212/WNL.0b013e318287281b
  38. Larsen BS, Kumarathurai P, Falkenberg J, Nielsen OW, Sajadieh A. Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation. J Am Coll Cardiol. 2015;66(3):232–41. https://doi.org/10.1016/j.jacc.2015.05.018
  39. Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Heart Rhythm. 2017;14(1):e3–40.

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