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REVEAL-AF: Silent AF Common in Patients at Risk for AF, Stroke

There is a high incidence of previously unrecognized, silent atrial fibrillation (AF) in patients at high risk for AF and stroke, according to a new study.

In the REVEAL AF study, silent AF as tracked by implanted monitor and lasting 6 minutes or longer occurred in about 30% of high-risk patients over a period of 18 months and 40% of patients at 30 months.

The prospective, single-arm, multicenter study, conducted at 57 centers in the US and Europe, enrolled 385 patients (mean age 71.5 years; 52.2% male) with a CHADS2 score of ≥3, or CHADS2=2 and at least one of the following risk factors: coronary artery disease, renal impairment (GFR 30–60 mL/min), sleep apnea, or chronic obstructive pulmonary disease. The patients were implanted with a rhythm-monitoring device (Reveal LINQ, Medtronic) to track their heart rhythm.

The LINQ recorder is about the size of two toothpicks put together. It"s really small. It doesn"t require surgery to implant, you can insert it through the skin with a plunger and patients tolerate it just fine. Insertion is an outpatient procedure, and it records for up to 3 years. In-office follow-up visits occurred every 6 months for a minimum of 18 and a maximum of 30 months. The median follow-up was 22.5 months.

The AF detection rate was 6.2% at 30 days and increased throughout the monitoring period. The incidence of AF was similar among patients with CHADS2 scores 2 (24.7%), 3 (32.7%), and >4 (31.7%; P=0.23). The median time from device insertion to detection of the first AF episode was 123 (interquartile range [IQR] 41–330) days.

Detection of silent AF has important public-health implications, investigators said. They believe silent atrial fibrillation is as important perhaps in terms of preventive therapy as previously recognized fibrillation.