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Advanced Stem Cell 2018 Journal of Stem Cell Biology and Transplantation
ISSN: 2575-7725 Page 31
December 03-04, 2018
Valencia, Spain
15th Edition of EuroSciCon Conference on
Advanced Stem Cell &
Regenerative Medicine
While clinical atrial fibrillation (AF), is a well-known risk factor for
stroke, the therapeutic implications for devicedetectedsubclinical
atrial fibrillation (SCAF) remain unknown. A review of 950 patients
with the implanted loop recorder revealed an incidence of SCAF
(> 6 minutes in duration) ranging from 22-34% at 18 months
follows up. Most episodes were asymptomatic and brief (<30
minutes). Several studies in patients with implanted pacemaker
or ICD showed an incidence of SCAF between 20-50% at 12-18
months follow up. Patients with SCAF had an increase in rates of
thrombo-embolic (TE) complications (HR 2-2.5), resulting in an
absolute TE risk of 1.0–2.5%/year. The stroke risk was highest in
patients with increased CHADS stroke risk score. A recent large
trial showed increased stroke rates only in patients with SCAF >
24 hrs duration. In this trial only 25% of SCAF episodes were >
24 hours in duration. Furthermore, in several trials, only 10-20%
had SCAF within 30 days prior to the TE event. The remainder
had either no SCAF, SCAF > 30 days prior to, or SCAF only after
the TE event. In patients with clinical AF, anticoagulation therapy
has been shown to reduce the risk of stroke; the benefit/risk ratio
is not clear for patients with SCAF. Two studies are currently
underway (ARTESIA NCT01938248 – NOAH NCT02618577)
randomizing patients with device detected SCAF (> 6 min) to
anticoagulation therapy versus placebo or aspirin. At the present
time, in light of unproven benefit, yet real bleeding risk, the use of
anticoagulation therapymay best be limited to patients with SCAF
> 24 hrs episode duration and increased CHADS/CHADSVAS
score. Close monitoring for the development of prolonged AF
episodes is warranted.
Biography
Peter Ott obtained hismedical degree from the University of Heidelberg, Ger-
many. After Internal Medicine residency (Tucson, Arizona), he pursued spe-
cialty training in cardiology (Denver, Colorado) and cardiac electrophysiology
(Salt Lake City, Utah). Since 1999 he is a leading member of the cardiac
electrophysiology section at the Sarver Heart Center, University of Arizona.
He has published in numerous reputed, peer-reviewed journals.
Subclinical atrial fibrillation: diagnosis and
therapeutic challenges
Peter Ott
Sarver Heart Center - Banner University Medical Center, USA
Peter Ott, J Stem Cell Biol Transplant 2018, Volume 2
DOI: 10.21767/2575-7725-C1-002