TABLE 1.
Review of studies investigating effect of AF burden on thromboembolic risk
| First Author, Year | N | Data Source | AF Burden Definition | Outcome |
|---|---|---|---|---|
| Clinical AF | ||||
| Hart,9 2000 | 2012 | SPAF I, II, III studies | Clinical classification of AF | No difference in risk of TE events with intermittent vs. sustained AF (3.2% vs. 3.3% per year) |
| Hohnholser,10 2007 | 6706 | ACTIVE-W study | Clinical classification of AF | No difference in risk of TE events with paroxysmal vs. sustained AF (RR 0.94, CI 0.63-1.40, p = 0.755) |
| Disertori,11 2013 | 1234 | GISSI study | Clinical classification of AF | No difference in risk of TE events with persistent vs. paroxysmal AF (HR 2.14, CI 0.68-6.79, p = 0.20) |
| Steinberg,12 2015 | 14062 | ROCKET-AF study | Clinical classification of AF | Increased risk of TE events with persistent vs. paroxysmal AF (HR 1.28, CI 1.01-1.64, p = 0.045) |
| Link,13 2017 | 21105 | ENGAGE AF-TIMI 48 study | Clinical classification of AF | Increased risk of TE events with persistent vs. paroxysmal AF (HR 1.27, CI 1.11-1.52, p = 0.015) and permanent vs. paroxysmal AF (HR 1.30, CI 1.15-1.43, p < 0.001) |
| Al-Khatib,14 2013 | 18201 | ARISTOTLE study | Clinical classification of AF | Increased risk of TE events with persistent or permanent AF vs. paroxysmal AF (HR 1.43, CI 1.08-1.96, p = 0.015) |
| Lip,15 2008 | 7329 | SPORTIF III and V studies | Clinical classification of AF | Increased risk of TE events with persistent vs. paroxysmal AF (HR 1.87, CI 1.04-3.36, p = 0.037) |
| Vanassche,16 2015 | 6563 | ACTIVE-A and AVERROES studies | Clinical classification of AF | Increased risk of ischemic stroke with persistent vs. paroxysmal (HR 1.44, CI 1.05-1.98, p = 0.02) and permanent vs. paroxysmal AF (HR 1.83, CI 1.43-2.35, p < 0.001) |
| Go,17 2018 | 1965 | KP-RHYTHM study | Percent time in AF | Increased risk of TE events with highest tertile of AF burden (≥11.4%) compared to lower tertiles (HR 3.16, CI 1.51-6.62) |
| Chew,18 2022 | 39710 | CIED data from Merlin.net remote monitoring database | Daily percent time in AF and maximum duration of any AF episode | Increased risk of ischemic stroke with maximum AF episode duration ≥24 hours (HR 1.366, CI 1.018-1.832, p = 0.038) |
| Device-detected AF | ||||
| Glotzer,19 2009 | 2486 | TRENDS study | Maximum daily duration of DDAF within a 30-day period | Increased risk of TE events with high AT/AF burden (≥5.5 hours) vs. no AT/AF burden (HR 2.20, CI 0.96-5.05, p = 0.06) |
| Van Gelder,20 2017 | 2580 | ASSERT study | Maximum single DDAF episode duration | Increased risk of TE events with DDAF duration > 24 hours vs. no DDAF (HR 3.24, CI 1.51-6.95, p = 0.003) |
| Boriani,21 2014 | 10016 | TRENDS, PANORAMA, and Italian ClinicalService Project studies | Maximum daily time in DDAF | Increased risk of ischemic stroke with ≥5 minutes DDAF (HR 1.76, CI 1.02-3.02, p = 0.041) |
| Kaplan,22 2019 | 21768 | Medtronic CareLink database | Maximum daily time in DDAF | Increased stroke risk (>1%/year) in patients with AF burden 6 min-23.5h and CHA2DS2VASc ≥3 and patients with AF burden >23.5h and CHA2DS2VASc ≥2 |
AF = atrial fibrillation, AT = atrial tachycardia, CIED = cardiac implantable electronic device, DDAF = device-detected atrial fibrillation, SCAF = subclinical atrial fibrillation, TE = thromboembolism