Anticoagulation in Subclinical Atrial Fibrillation: The ARTESiA Trial

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My name is Jeff Healey, and I'm the director of cardiology at McMaster University in Hamilton, Ontario, Canada. At the upcoming Western Atrial Fibrillation (AF) Symposium, I'll be discussing the very hot topic of device-detected AF. Now, this is the type of AF traditionally picked up by pacemakers or defibrillators, but has become even more interesting with the development of implantable cardiac monitors and consumer-facing devices such as smartphones and watches, which can all diagnose asymptomatic AF. To put it into context, previously we have talked about atrial high-rate episodes and subclinical AF, but really, these all refer to the same thing—AF picked up with long-term monitoring through devices. So, this will be an interesting topic. We have 2 very recent large clinical trials, the NOAH-AFNET 6 trial done in Europe, and the ARTESiA trial done in North America and Europe, where we evaluated the use of oral anticoagulants for preventing stroke with this type of arrhythmia. We will also discuss how this is important for prediction of heart failure and other cardiovascular events in patients with device-detected AF. Then finally, we will focus attention on the very hot topic of screening for AF in the broader population.

What are the take-home messages you would like viewers to leave with?

On the topic of device-detected AF, first of all, viewers need to know they need an approach for this, because whether or not it's found in the clinic, patients will be presenting to your office with a self-diagnosis via a variety of consumer-facing technologies. So, we really do need to understand this frontier of AF. It's great that we now have some data to support recommendations in this regard. With the use of anticoagulants there is still some of that story remaining to be told, but we know the anticoagulants do reduce the risk of stroke, although the baseline risk of stroke in many of these individuals is relatively low. So, we need to understand the emerging data to understand who to treat and who to follow closely for the development of longer-lasting AF. Of course, there are many trials ongoing to determine if screening at a population level makes sense. The data aren't quite there yet, although many trials are underway which should answer these questions in the coming years. So, lots to know about device-detected AF. It is very relevant in the general population as well as other populations such as post-stroke and patients who have had AF ablation.

What are you looking forward to at the Western AF Symposium?

As always, the Western AF Symposium is a really great opportunity to meet and hear from some of the top names and thinkers in the field of AF. It's a very up close and personal chance to interact with experts, ask questions, and have a different type of discussion than you would get from simply reading papers or seeing abstracts presented at major meetings. So, I like the fact that there are just so many interesting, smart individuals who understand the topic of AF very well, and a lot of great discussions happen at the Western AF Symposium.