Oral anticoagulation in device-detected atrial fibrillation: effects of age, sex, cardiovascular comorbidities, and kidney function on outcomes in the NOAH-AFNET 6 trial

Gregory Y H  Lip; Julius Nikorowitsch; Susanne Sehner; Nina Becher; Emanuele Bertaglia; Carina Blomström-Lundqvist; Axel Brandes; Vincent Beuger; Melanie Calvert; Alan  John  Camm; Gregory Chlouverakis; Gheorghe-Andrei Dan; Wolfgang Dichtl; Hans Christoph Diener; Alexander Fierenz; Andreas Goette; Joris R de Groot; Astrid Hermans; Andrzej Lubinski; Eloi Marijon; Bela Merkely; Lluis Mont; Ann-Kathrin Ozga; Kim Rajappan; Andreas Sarkozy; Daniel Scherr; Renate Schnabel; Ulrich Schotten; Emmanuel Simantirakis; Tobias Toennis; Panos Vardas; Daniel Wichterle; Antonia Zapf; Paulus Kirchhof

doi:10.1093/eurheartj/ehae225

Oral anticoagulation in device-detected atrial fibrillation: effects of age, sex, cardiovascular comorbidities, and kidney function on outcomes in the NOAH-AFNET 6 trial

Gregory Y H Lip
, Julius Nikorowitsch
, Susanne Sehner
, Nina Becher
, Emanuele Bertaglia
, Carina Blomström-Lundqvist
, Axel Brandes
, Vincent Beuger
, Melanie Calvert
, Alan John Camm
, Gregory Chlouverakis
, Gheorghe-Andrei Dan
, Wolfgang Dichtl
, Hans Christoph Diener
, Alexander Fierenz
, Andreas Goette
, Joris R de Groot
, Astrid Hermans
, Andrzej Lubinski
, Eloi Marijon

Bela Merkely, Lluis Mont, Ann-Kathrin Ozga, Kim Rajappan, Andreas Sarkozy, Daniel Scherr, Renate Schnabel, Ulrich Schotten, Emmanuel Simantirakis, Tobias Toennis, Panos Vardas, Daniel Wichterle, Antonia Zapf, Paulus Kirchhof^*

^*Corresponding author for this work

Applied Health Sciences

Research output: Contribution to journal › Letter › peer-review

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Abstract

Implanted pacemakers, defibrillators, and loop recorders detect short and rare episodes of device-detected atrial fibrillation [DDAF, previously also called atrial high-rate episodes or subclinical atrial fibrillation (AF)] in ∼30% of patients. Device-detected atrial fibrillation rarely has therapeutic consequences in patients with ECG-documented AF. Device-detected atrial fibrillation without ECG-documented AF can lead to consideration of oral anticoagulation in clinical practice, especially in older patients with multiple stroke risk factors and/or very long DDAF episodes, largely based on observational data. Two recent controlled trials, NOAH-AFNET 6 and ARTESiA, observed a low rate of ischaemic stroke without anticoagulation (1.1%–1.2%/patient-year) in patients with DDAF and stroke risk factors, including in patients with very long DDAF episodes in NOAH-AFNET 6. Current guidelines leave the decision to anticoagulate to clinical judgement, balancing the expected stroke risk, typically estimated by using stroke risk scores developed in patients with ECG-documented AF, and the stroke risk reduction induced by anticoagulation, with the increase in bleeding associated with anticoagulation therapy.

Original language	English
Article number	ehae225
Journal	European Heart Journal
DOIs	https://doi.org/10.1093/eurheartj/ehae225
Publication status	Published - 9 Apr 2024

Bibliographical note

NOAH-AFNET 6 was partially funded by BMBF (German Ministry of Education and Research, Berlin, Germany) through the DZHK (German Center for Cardiovascular Research, Berlin, Germany, grant number FKZ 81X2800182) and by Daiichi Sankyo Europe. Further support was provided by European Union CATCH ME (grant agreement No 633196) to P.K. and U.S. and AFNET; AFFECT-EU (grant agreement 847770) to P.K.; MAESTRIA (grant agreement 965286) to A.G., P.K., U.S., and AFNET; British Heart Foundation (AA/18/2/34218) to P.K.; German Research Foundation (Ki 509167694) to P.K.; DZHK (grant numbers 81Z0710116 and 81Z0710110) to P.K., Leducq Foundation to P.K., and the Dutch Heart Foundation (EmbRACE, grant number 01-002-2022-0118) to U.S. U.S. received grants from Roche (to institution).

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Lip, G. Y. H., Nikorowitsch, J., Sehner, S., Becher, N., Bertaglia, E., Blomström-Lundqvist, C., Brandes, A., Beuger, V., Calvert, M., Camm, A. J., Chlouverakis, G., Dan, G.-A., Dichtl, W., Diener, H. C., Fierenz, A., Goette, A., de Groot, J. R., Hermans, A., Lubinski, A., ... Kirchhof, P. (2024). Oral anticoagulation in device-detected atrial fibrillation: effects of age, sex, cardiovascular comorbidities, and kidney function on outcomes in the NOAH-AFNET 6 trial. European Heart Journal, Article ehae225. https://doi.org/10.1093/eurheartj/ehae225

@article{706bd89c9ac24e8f93eca8e1e3a0170c,

title = "Oral anticoagulation in device-detected atrial fibrillation: effects of age, sex, cardiovascular comorbidities, and kidney function on outcomes in the NOAH-AFNET 6 trial",

abstract = "Implanted pacemakers, defibrillators, and loop recorders detect short and rare episodes of device-detected atrial fibrillation [DDAF, previously also called atrial high-rate episodes or subclinical atrial fibrillation (AF)] in ∼30\% of patients. Device-detected atrial fibrillation rarely has therapeutic consequences in patients with ECG-documented AF. Device-detected atrial fibrillation without ECG-documented AF can lead to consideration of oral anticoagulation in clinical practice, especially in older patients with multiple stroke risk factors and/or very long DDAF episodes, largely based on observational data. Two recent controlled trials, NOAH-AFNET 6 and ARTESiA, observed a low rate of ischaemic stroke without anticoagulation (1.1\%–1.2\%/patient-year) in patients with DDAF and stroke risk factors, including in patients with very long DDAF episodes in NOAH-AFNET 6. Current guidelines leave the decision to anticoagulate to clinical judgement, balancing the expected stroke risk, typically estimated by using stroke risk scores developed in patients with ECG-documented AF, and the stroke risk reduction induced by anticoagulation, with the increase in bleeding associated with anticoagulation therapy.",

author = "Lip, \{Gregory Y H\} and Julius Nikorowitsch and Susanne Sehner and Nina Becher and Emanuele Bertaglia and Carina Blomstr{\"o}m-Lundqvist and Axel Brandes and Vincent Beuger and Melanie Calvert and Camm, \{Alan John\} and Gregory Chlouverakis and Gheorghe-Andrei Dan and Wolfgang Dichtl and Diener, \{Hans Christoph\} and Alexander Fierenz and Andreas Goette and \{de Groot\}, \{Joris R\} and Astrid Hermans and Andrzej Lubinski and Eloi Marijon and Bela Merkely and Lluis Mont and Ann-Kathrin Ozga and Kim Rajappan and Andreas Sarkozy and Daniel Scherr and Renate Schnabel and Ulrich Schotten and Emmanuel Simantirakis and Tobias Toennis and Panos Vardas and Daniel Wichterle and Antonia Zapf and Paulus Kirchhof",

note = "NOAH-AFNET 6 was partially funded by BMBF (German Ministry of Education and Research, Berlin, Germany) through the DZHK (German Center for Cardiovascular Research, Berlin, Germany, grant number FKZ 81X2800182) and by Daiichi Sankyo Europe. Further support was provided by European Union CATCH ME (grant agreement No 633196) to P.K. and U.S. and AFNET; AFFECT-EU (grant agreement 847770) to P.K.; MAESTRIA (grant agreement 965286) to A.G., P.K., U.S., and AFNET; British Heart Foundation (AA/18/2/34218) to P.K.; German Research Foundation (Ki 509167694) to P.K.; DZHK (grant numbers 81Z0710116 and 81Z0710110) to P.K., Leducq Foundation to P.K., and the Dutch Heart Foundation (EmbRACE, grant number 01-002-2022-0118) to U.S. U.S. received grants from Roche (to institution).",

year = "2024",

month = apr,

day = "9",

doi = "10.1093/eurheartj/ehae225",

language = "English",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

}

Lip, GYH, Nikorowitsch, J, Sehner, S, Becher, N, Bertaglia, E, Blomström-Lundqvist, C, Brandes, A, Beuger, V, Calvert, M, Camm, AJ, Chlouverakis, G, Dan, G-A, Dichtl, W, Diener, HC, Fierenz, A, Goette, A, de Groot, JR, Hermans, A, Lubinski, A, Marijon, E, Merkely, B, Mont, L, Ozga, A-K, Rajappan, K, Sarkozy, A, Scherr, D, Schnabel, R, Schotten, U, Simantirakis, E, Toennis, T, Vardas, P, Wichterle, D, Zapf, A & Kirchhof, P 2024, 'Oral anticoagulation in device-detected atrial fibrillation: effects of age, sex, cardiovascular comorbidities, and kidney function on outcomes in the NOAH-AFNET 6 trial', European Heart Journal. https://doi.org/10.1093/eurheartj/ehae225

TY - JOUR

T1 - Oral anticoagulation in device-detected atrial fibrillation

T2 - effects of age, sex, cardiovascular comorbidities, and kidney function on outcomes in the NOAH-AFNET 6 trial

AU - Lip, Gregory Y H

AU - Nikorowitsch, Julius

AU - Sehner, Susanne

AU - Becher, Nina

AU - Bertaglia, Emanuele

AU - Blomström-Lundqvist, Carina

AU - Brandes, Axel

AU - Beuger, Vincent

AU - Calvert, Melanie

AU - Camm, Alan John

AU - Chlouverakis, Gregory

AU - Dan, Gheorghe-Andrei

AU - Dichtl, Wolfgang

AU - Diener, Hans Christoph

AU - Fierenz, Alexander

AU - Goette, Andreas

AU - de Groot, Joris R

AU - Hermans, Astrid

AU - Lubinski, Andrzej

AU - Marijon, Eloi

AU - Merkely, Bela

AU - Mont, Lluis

AU - Ozga, Ann-Kathrin

AU - Rajappan, Kim

AU - Sarkozy, Andreas

AU - Scherr, Daniel

AU - Schnabel, Renate

AU - Schotten, Ulrich

AU - Simantirakis, Emmanuel

AU - Toennis, Tobias

AU - Vardas, Panos

AU - Wichterle, Daniel

AU - Zapf, Antonia

AU - Kirchhof, Paulus

N1 - NOAH-AFNET 6 was partially funded by BMBF (German Ministry of Education and Research, Berlin, Germany) through the DZHK (German Center for Cardiovascular Research, Berlin, Germany, grant number FKZ 81X2800182) and by Daiichi Sankyo Europe. Further support was provided by European Union CATCH ME (grant agreement No 633196) to P.K. and U.S. and AFNET; AFFECT-EU (grant agreement 847770) to P.K.; MAESTRIA (grant agreement 965286) to A.G., P.K., U.S., and AFNET; British Heart Foundation (AA/18/2/34218) to P.K.; German Research Foundation (Ki 509167694) to P.K.; DZHK (grant numbers 81Z0710116 and 81Z0710110) to P.K., Leducq Foundation to P.K., and the Dutch Heart Foundation (EmbRACE, grant number 01-002-2022-0118) to U.S. U.S. received grants from Roche (to institution).

PY - 2024/4/9

Y1 - 2024/4/9

N2 - Implanted pacemakers, defibrillators, and loop recorders detect short and rare episodes of device-detected atrial fibrillation [DDAF, previously also called atrial high-rate episodes or subclinical atrial fibrillation (AF)] in ∼30% of patients. Device-detected atrial fibrillation rarely has therapeutic consequences in patients with ECG-documented AF. Device-detected atrial fibrillation without ECG-documented AF can lead to consideration of oral anticoagulation in clinical practice, especially in older patients with multiple stroke risk factors and/or very long DDAF episodes, largely based on observational data. Two recent controlled trials, NOAH-AFNET 6 and ARTESiA, observed a low rate of ischaemic stroke without anticoagulation (1.1%–1.2%/patient-year) in patients with DDAF and stroke risk factors, including in patients with very long DDAF episodes in NOAH-AFNET 6. Current guidelines leave the decision to anticoagulate to clinical judgement, balancing the expected stroke risk, typically estimated by using stroke risk scores developed in patients with ECG-documented AF, and the stroke risk reduction induced by anticoagulation, with the increase in bleeding associated with anticoagulation therapy.

AB - Implanted pacemakers, defibrillators, and loop recorders detect short and rare episodes of device-detected atrial fibrillation [DDAF, previously also called atrial high-rate episodes or subclinical atrial fibrillation (AF)] in ∼30% of patients. Device-detected atrial fibrillation rarely has therapeutic consequences in patients with ECG-documented AF. Device-detected atrial fibrillation without ECG-documented AF can lead to consideration of oral anticoagulation in clinical practice, especially in older patients with multiple stroke risk factors and/or very long DDAF episodes, largely based on observational data. Two recent controlled trials, NOAH-AFNET 6 and ARTESiA, observed a low rate of ischaemic stroke without anticoagulation (1.1%–1.2%/patient-year) in patients with DDAF and stroke risk factors, including in patients with very long DDAF episodes in NOAH-AFNET 6. Current guidelines leave the decision to anticoagulate to clinical judgement, balancing the expected stroke risk, typically estimated by using stroke risk scores developed in patients with ECG-documented AF, and the stroke risk reduction induced by anticoagulation, with the increase in bleeding associated with anticoagulation therapy.

U2 - 10.1093/eurheartj/ehae225

DO - 10.1093/eurheartj/ehae225

M3 - Letter

SN - 0195-668X

JO - European Heart Journal

JF - European Heart Journal

M1 - ehae225

ER -

Oral anticoagulation in device-detected atrial fibrillation: effects of age, sex, cardiovascular comorbidities, and kidney function on outcomes in the NOAH-AFNET 6 trial

Abstract

Bibliographical note

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