REVEAL AF study

Reiffel JA et al.: Rhythm monitoring strategies in patients at high risk for atrial fibrillation and stroke: A comparative analysis from the REVEAL AF study. Am Heart J 219 (2020):128-136.
doi: 10.1016/j.ahj.2019.07.016

Ergebnisse aus der REVEAL AF study: Bei 385 Patienten im Alter von durchschnittlich 71.5 Jahren wurde mittels implantiertem Event-Recorder innerhalb eines Jahres bei 27.1 % Vorhofflimmern > 6 Min. Dauer festgestellt. Mit konventionellen Methoden lag die Erkennungsrate für solche Episoden zwischen 0.8 % (einmaliges 24-Std.-LZ-EKG) und 10.6 % (7-Tage-LZ-EKG alle 3 Monate).

BACKGROUND:
Reducing atrial fibrillation (AF)-related stroke requires timely AF diagnosis, but the optimal monitoring strategy is unknown.
OBJECTIVE:
We used insertable cardiac monitor (ICM) data from the REVEAL AF study to compare AF detection rates by various short-term continuous monitoring (STM) strategies.
METHODS AND RESULTS:
Patients without known AF, but with CHADS2 scores ≥3 (or = 2 with ≥1 additional AF risk factor) received an ICM for AF detection. One-time STM strategies were assessed by computing AF incidence at 1, 2, 7, 14, and 30 days post-ICM insertion. Repeated STM strategies (quarterly 24-hour, 48-hour, 7-day, or monthly 24-hour monitoring) were modeled by randomly selecting day(s) within a 30-day window around each nominal evaluation date over a 1-year period (simulated 10,000 times). Endpoints included AF ≥6 minutes, AF ≥1 hour, and daily AF burden ≥1 and ≥ 5.5 hours. The impact of compliance on AF detection was evaluated using daily compliance rates of 85%, 75%, 65% and 55% during follow-up months 1-3, 4-6, 7-9, and 9-12, respectively. Based on data from 385 patients (71.5 ± 9.9 years; CHADS2 score 3.0 ± 1.0) the incidence of AF ≥6 minutes via ICM at 12 months was 27.1% (95% CI, 22.5-31.5%). This exceeded the range of estimated rates from all modeled one-time and repeated STM strategies (0.8% for 24-hour Holter monitoring to 10.6% for quarterly 7-day monitoring). Findings were similar for all AF endpoints. Modeled non-compliance reduced AF detection by 4.5% to 22.9%.
CONCLUSIONS:
Most AF episodes detected via ICMs would go undetected via conventional STM strategies, thus preventing optimal prophylaxis for adverse consequences.

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