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Halimi F, Sabouret P, Huberman JP, Cohen S, Ouazana L, Hoffman O, Assouline S, Guedj-Meynier D, Schwartz J, Weiss P, Lafont C, Lellouche N. Atrial fibrillation diagnosis by a systematic 14-day continuous ECG-Holter in patients with high cardiovascular risk and clinical palpitation: the prospective AFTER study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial Fibrillation (AF) is asymptomatic in 20–30% of cases. New technologic tools for continuous ECG monitoring have been developed to detect and potentially treat AF in specific population with high cardiovascular risk.
Purpose
We aimed to evaluate the prevalence and the management of AF diagnosed in patients with no previous documented AF but with a high cardiovascular risk and clinical palpitation undergoing systematic 14-day continuous ECG-Holter monitoring and associated characteristics.
Methods
Patients were prospectively enrolled from December 2019 to December 2021 in this multicentered study, sponsored by the French National College of Cardiology. Patients needed to meet the following criteria: CHA2DS2VASc score ≥3 in women >2 in men associated with clinical palpitation without previous documented arrhythmia, particularly AF. Exclusion criteria were: previous documented AF, participation to another study that could interfere with the current study, pregnancy, previous skin intolerance to ECG-Holter electrodes. Included patients underwent a 14-day monitoring Holter-ECG to detect cardiac arrhythmia, particularly AF. Patients' characteristics, type of arrythmias and management of detected AF were described.
Results
Among the 336 included patients, 39% were men, median age was 73 [64.5–78] years, 71.5% had hypertension and 46.5% had a previous history of stroke. AF was detected in 14% of patients, among which 23.4% in the first 24 hours monitoring. In univariate analyses, older age (p=0.045) was significantly associated with AF, and a trend was observed regarding male gender (p=0.067) and less antiplatelet therapy (p=0.058). Patients with diagnosed AF had a prescription of anticoagulation therapy in 90% of cases consisting in apixaban and rivaroxaban for 72% and 28% respectively. Antiarrhythmic drugs were administered in 90% of AF patients and 13% underwent AF ablation.
Conclusions
The systematic AF screening of selected patients based on CHA2DS2VASc score ≥3 in women >2 in men associated with palpitations allows to diagnose AF in 14% of the population with a 14-day continuous ECG-Holter. This strategy seems efficient as it induced the prescription of anticoagulation and antiarrhythmic therapy in 90% of individuals.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): NATIONAL COLLEGE OF FRENCH CARDIOLOGISTS
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Affiliation(s)
- F Halimi
- Private Hopital of Parly II, Rythmology , Le Chesnay , France
| | - P Sabouret
- Hospital Pitie-Salpetriere , Paris , France
| | - J P Huberman
- National College of French Cardiologists, Cardiology , Paris , France
| | - S Cohen
- National College of French Cardiologists, Cardiology , Paris , France
| | - L Ouazana
- National College of French Cardiologists, Cardiology , Paris , France
| | - O Hoffman
- National College of French Cardiologists, Cardiology , Paris , France
| | - S Assouline
- National College of French Cardiologists, Cardiology , Paris , France
| | - D Guedj-Meynier
- National College of French Cardiologists, Cardiology , Paris , France
| | - J Schwartz
- National College of French Cardiologists, Cardiology , Paris , France
| | - P Weiss
- National College of French Cardiologists, Cardiology , Paris , France
| | - C Lafont
- University Hospital Henri Mondor, Public Health , Creteil , France
| | - N Lellouche
- University Hospital Henri Mondor, Rythmology Department , Creteil , France
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Halimi F, Sabouret P, Huberman JP, Ouazana L, Guedj D, Djouadi K, Dhanjal TS, Goette A, Lafont C, Lellouche N. Atrial fibrillation detection with long-term continuous Holter ECG recording in patients with high cardiovascular risk and clinical palpitations: the prospective after study. Clin Res Cardiol 2022:10.1007/s00392-022-02109-9. [PMID: 36169720 DOI: 10.1007/s00392-022-02109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022]
Abstract
AIM New technologic tools for continuous ECG monitoring have been developed to detect and treat atrial fibrillation (AF) in specific populations with high cardiovascular risk. We evaluated the prevalence and the management of AF diagnosed in patients with high cardiovascular risk and non-documented clinical palpitation undergoing systematic 14-day continuous ECG-Holter monitoring. METHODS Patients were prospectively enrolled from December 2019 to December 2021 in this multicentre study, sponsored by the French National College of Cardiology. Patients met the following criteria: CHA2DS2VASc score ≥ 2 in males and ≥ 3 in females and clinical palpitations without previously documented arrhythmia. Enrolled patients underwent a continuous 14-day Holter-ECG monitoring for arrhythmia detection. RESULTS Among the 336 included patients, 39% were male, 75% were greater than 65 years of age and 46.5% had suffered a prior stroke. AF was detected in 14% of patients, among which 23.4% were detected in the first 24 h of monitoring. Finally, age ≥ 65 years (p = 0.037) was significantly associated with AF, as well as male gender (p = 0.023) and a lower rate of antiplatelet therapy (p = 0.018). Patients with diagnosed AF had a prescription of anticoagulation therapy in 90%. Antiarrhythmic drugs were administered in 90% of AF patients and 13% underwent AF ablation. CONCLUSIONS The systematic AF screening of patients with palpitations and high cardiovascular risk resulted in a diagnostic yield of AF in 14% of the population with a 14-day continuous ECG-Holter monitor. This strategy resulted in the prescription of anticoagulation and antiarrhythmic therapy in 90% of the AF detected population.
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Affiliation(s)
- F Halimi
- Hôpital Privé, Parly 2, 21 rue Moxouris, 78150, Le Chesnay, France
| | - P Sabouret
- Department of Cardiology, AP-HP, University Hospital Pitié-Salpétrière, Creteil, France
| | - J P Huberman
- French College of Cardiology, 75014, Paris, France
| | - L Ouazana
- French College of Cardiology, 75014, Paris, France
| | - D Guedj
- French College of Cardiology, 75014, Paris, France
| | - K Djouadi
- Department of Cardiology, AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Creteil, France
| | - T S Dhanjal
- Department of Cardiac Electrophysiology, University of Warwick, Gibbet Hill, Coventry, UK
| | - A Goette
- Department of Cardiac Electrophysiology, St Vincenz Kliniken, Paderborn, Germany
| | - C Lafont
- Univ Paris Est Creteil, INSERM, IMRB, 94010, Creteil, France.,Service de Santé Publique, AP-HP, Hôpital Henri-Mondor, 94010, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology, AP-HP, University Hospital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94000, Creteil, France.
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Thomas D, Lascault G, Caille B, Drobinski G, Huberman JP, Shqueir A, Grosgogeat Y. [Familial forms of interauricular communication of the ostium secundum type]. Arch Mal Coeur Vaiss 1985; 78:1205-9. [PMID: 3935078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The occurrence of several cases of ASD in the same family is rare. Familial forms of ASD are characterised by the high incidence of associated cardiac lesions in affected patients or in the family, by the frequency of atrioventricular block with prolongation of the PR interval and by the presence of a large defect in the interatrial septum. The condition is thought to be transmitted in an autosomal dominant manner. The authors report the case of a family in which 7 cases of ASD were found, 6 of which were repaired surgically. There were no associated cardiac or extracardiac malformations; AV conduction was normal in 4 of the 6 operated cases--the defects were all large. The study of the genealogical tree with examination of most members of the family suggests autosomal dominant transmission of the condition.
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Drobinski G, Evans JI, Eugène M, Laurenceau JL, Huberman JP, Bèjean-Lebuisson A, Thomas D, Grosgogeat Y. [Assessment of the degree of severity of aortic stenosis. Clinical, mechanographic, echographic and hemodynamic study of 22 cases]. Arch Mal Coeur Vaiss 1981; 74:21-7. [PMID: 6781435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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