The Quest for the Optimal AF Burden Cut-off to Guide Stroke Prevention

Interview With Andrea M. Russo, MD, FACC, FHRS, FAHA

In this onsite interview at the Western Atrial Fibrillation (AFib) Symposium, we talk with Andrea M. Russo, MD, FACC, FHRS, FAHA, from Cooper University Hospital in Camden, New Jersey.

Please introduce yourself.

Hi, I am Andrea Russo. I am the director of the electrophysiology program and academic chief at Cooper University Health System in New Jersey. I am focused on the treatment of patients who have AFib.

What can you tell us about your presentation at Western AFib?

We know that patients who have electrocardiographic evidence of clinical AFib that has been documented increases the risk of stroke, and if they are placed on anticoagulation, it reduces the risk of stroke. What we do not know is if these very short episodes of AFib lasting just a few minutes to less than 24 hours, which are detected on implanted devices such as pacemakers, defibrillators, loop recorders, or even watches or other wearable devices, have clinical significance in terms of stroke risk and whether anticoagulation reduces the risk of stroke.

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

For AFib that is over 24 hours in duration and clinical risk factors for stroke based on the CHA₂DS₂-VASc score, anticoagulation would be started for a CHA₂DS₂-VASc score greater than or equal to 2 in men and greater than or equal to 3 in women. For shorter episodes of AFib, we are still uncertain about how much AFib is relevant to require treatment with anticoagulation. We are fortunate to have some multicenter trials, including ARTESiA and NOAH, that will help us answer those questions. We will soon know which patients with subclinical AFib lasting <24 hours, combining clinical risk factors and AFib burden, should be treated with anticoagulation.

How does attending the Western AFib Symposium help improve patient care?

Getting the latest information for our patients helps us deliver evidence-based care. It can take a while for all this information to get disseminated and compiled into guidelines. But being here at Western AFib, we get the information right away and can quickly apply this to our patients back home.