Atrial fibrillation (AF) and Atrial Tachyarrhythmias
(AT) are the most common clinical arrhythmias and their worst issue is a
well-recognized correlation with ischemic stroke. Their detection results
difficult by using the traditional monitoring techniques due to their often
paroxysmal and asymptomatic nature. They may be unmasked only with a more
aggressive monitoring technique. Pacemakers and implantable cardioverter
defibrillators should be seen not only as therapeutic devices but also as
diagnostic tools that can prevent serious adverse events, particularly
thromboembolic ones. Moreover, the need of implanted cardiac devices whose sole
purpose would be to detect previously undiagnosed arrhythmias, such as AF/AT,
is nowadays taken into account by the Guidelines recommendations. This may lead
to a more patient-centered approach where each individual can tailor the use of
anticoagulants through consideration of the presence and duration of AF
episodes, in addition to clinical risk scores. These data become meaningful if
they are early available: today this is possible thanks to the daily remote
monitoring of the devices. Effectiveness of remote monitoring in early
detecting and treating atrial fibrillation, as well as in monitoring therapy
effects and patient clinical status, has been demonstrated. However, the
clinical evidence for stroke risk reduction by remote monitoring is still
awaited. This new available technology needs a new organizational model to
improve device and patient management and optimize resource utilization.
Credits: Daniele Giacopelli; Elia De Maria