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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EDuring this session, experts discussed various approaches to the management of new-onset atrial fibrillation (AF). Specific topics include AF in patients presenting with myocardial infarction, cardioversion therapy, anticoagulation therapy, as well as patients with minimal symptoms.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EDuring this session, experts discussed various approaches to the management of new-onset atrial fibrillation (AF). Antonio Raviele, MD, Alliance to Fight Atrial Fibrillation, Mestre, Venice, Italy, opened the session with a discussion of AF in patients presenting with myocardial infarction.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDespite the widespread use of reperfusion and pharmacologic therapies, AF remains a commonly encountered complication of acute myocardial infarction (AMI) that is associated with an excess risk of reinfarction, heart failure (HF), stroke, and mortality [Jabre P et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2011]. Several possible mechanisms for, and predictors of, the development of AF in the presence of AMI have been identified (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETables 1\u003C\/a\u003E and \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003E2\u003C\/a\u003E). Once AF develops, there is usually a significant worsening of hemodynamics, owing to high ventricular rate, irregular ventricular filling, and loss of the atrial contribution to cardiac output.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15352\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15352\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15352\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EPotential Mechanisms for AF in Patients With AMI\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15353\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15353\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15353\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EPredictors of AF in Patients With AMI\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EIn many cases, the arrhythmia is well tolerated, and no additional treatment is required, as these patients commonly receive rate control and antithrombotic therapy for the index AMI. However, in some patients, the high ventricular rate associated with AF may contribute to hemodynamic impairment and the development of HF and thus require intervention with diuretics, additional rate or rhythm agents, and\/or cardioversion.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EAccording to the most recent position paper from the Joint European Heart Rhythm Association, Acute Cardiovascular Care Association, and European Association of Percutaneous Cardiovascular Interventions Task Force, adequate rate control represents the most important first therapeutic approach in patients with AMI with AF and rapid ventricular response [Gorenek B et al. \u003Cem\u003EEuropace\u003C\/em\u003E. 2014]. In stable patients, \u03b2-blockers or calcium channel blockers are recommended to reduce high ventricular rate. In patients with severe left ventricular dysfunction or HF, intravenous amiodarone and\/or digitalis are recommended [Camm AJ et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2010]. Acute initiation of rate control therapy should be followed by a long-term strategy. Although few data are available, the consensus indicates that the optimal level of rate control in patients with AF and AMI should be 80 to 100 beats per minute (bpm). When adequate rate control cannot be achieved, urgent cardioversion is required, especially in patients with severe hemodynamic instability or intractable ischemia.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EAccording to Michiel Rienstra, MD, PhD, University Medical Center, Groningen, The Netherlands, electrical cardioversion is more effective than pharmacologic cardioversion, and it is the treatment of choice in unstable patients. There are, however, advantages to a pharmacologic approach: It does not require sedation, and successful in-hospital treatment can provide guidance on the antiarrhythmic choice for ongoing management. The choice of antiarrhythmic agent should be based on the duration of the AF and the presence of structural heart disease.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EOver time, AF generally progresses to a permanent form. The management of new-onset AF begins with a stroke risk assessment, followed by an assessment of the need for oral anticoagulant therapy and rate control therapy. Elective electrical cardioversion may also be considered to prevent atrial remodeling [Camm AJ et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2010]. Silvia Zagnoni, MD, Ospedale Maggiore, Bologna, Italy, discussed strategies for anticoagulation therapy (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) in the setting of cardioversion.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/42\/16\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Anticoagulation Protocol for Cardioversion\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-631768829\u0022 data-figure-caption=\u0022Anticoagulation Protocol for Cardioversion\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/42\/16\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/42\/16\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/42\/16\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15351\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003EAnticoagulation Protocol for Cardioversion\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAF, atrial fibrillation; LAA, left atrial appendage; OAC, oral anticoagulants; SR, sinus rhythm; TOE, transesophageal echocardiogram.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003E\n            \u003Csup\u003Ea\u003C\/sup\u003EAnticoagulation should normally be continued for 4 weeks after a cardioversion attempt except when AF is recent onset and no risk factors are present.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003E\n            \u003Csup\u003Eb\u003C\/sup\u003ELong-term OAC if stroke risk factors and\/or risk of AF recurrence\/presence of thrombus.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EAdapted from Camm AJ et al, Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC).\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-5\u0022\u003E\n            \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2010;31:2369\u20132429. With permission from European Society of Cardiology.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-13\u0022\u003EFor patients with AF of \u0026gt; 48-hour duration (or if the duration is unknown), current guidelines call for the use of either vitamin K antagonists (VKAs) with a target international normalized ratio of 2 to 3 or dabigatran for \u2265 3 weeks prior to and \u2265 4 weeks after cardioversion [Camm AJ et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2012]. In patients with risk factors for stroke or AF recurrence, oral anticoagulation therapy should be continued lifelong.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EAlthough multiple randomized placebo-controlled trials have confirmed novel oral anticoagulants (NOACs) to be as effective as VKA, there is less evidence confirming their efficacy in the setting of cardioversion, derived mainly from post hoc analysis of performed cardioversions during the NOAC trials and observational small registries. Nowadays, the available data on the use of a NOAC in the setting of cardioversion after 3 weeks of anticoagulation derive from a single randomized trial: X-VeRT [Ezekowitz MD et al. \u003Cem\u003EAm Heart J.\u003C\/em\u003E 2014]. Since compliance with NOAC use cannot be confirmed with a laboratory test, patients must be explicitly asked about their levels of compliance preceding a cardioversion; if there is any uncertainty concerning a patient\u0027s compliance, a transesophageal echocardiogram should be considered to rule out left atrial appendage thrombus.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EMichael Glikson, MD, Davidai Arrhythmia Venter, Heart Institute, Sheba Medical Center, Tel Hashomer, Israel, discussed the management of new-onset AF in patients with minimal symptoms. Current European Society of Cardiology guidelines call for screening of AF in patients aged \u2265 65 years via pulse taking, followed by an electrocardiogram (class A; level of evidence B) [Camm AJ. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2012]. Subtle symptoms that may be indicative of HF should also be identified (eg, as evaluated through an European Heart Rhythm Association score). Consideration should be given to whether anticoagulation is recommended for thromboembolic risk reduction (ie, CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc score \u2265 1), bleeding risk considerations (HAS-BLED), and current level of rate control. Basic evaluation tools are show in \u003Ca id=\u0022xref-table-wrap-3-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T3\u0022\u003ETable 3\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022T3\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15354\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15354\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15354\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 3.\u003C\/span\u003E \n            \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003EBasic Tools for the Evaluation of Atrial Fibrillation\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-18\u0022\u003EWith certain exceptions (\u003Ca id=\u0022xref-table-wrap-4-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T4\u0022\u003ETable 4\u003C\/a\u003E), rate control with anticoagulation is the preferred approach in most elderly patients with asymptomatic AF (class I; level of evidence A) [Camm AJ et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2010]. Based on data from the RACE II study\u2014which found no difference in clinical outcomes [Van Gelder IC et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2010] or quality of life [Groenveld HF et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E. 2011] between lenient rate control (resting rate \u0026lt; 110 bpm) and strict rate control (rest \u0026lt; 80 bpm; moderate exercise \u0026lt; 110 bpm)\u2014Prof Glikson and the guidelines recommend lenient rate control for patients with asymptomatic AF.\u003C\/p\u003E\u003Cdiv id=\u0022T4\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15355\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15355\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15355\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 4.\u003C\/span\u003E \n            \u003Cp id=\u0022p-19\u0022 class=\u0022first-child\u0022\u003EPatients for Whom a Rhythm Control Strategy Is Preferred\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-21\u0022\u003EAbout 20% to 30% of elderly patients with a cardiovascular implantable electronic device (CIED) and no prior diagnosis of AF have evidence of AF on device interrogation. Several studies have assessed the prognostic and therapeutic significance of this finding in an attempt to determine whether there is a critical duration or burden of AF that justifies anticoagulation, but the results have been inconsistent. Prof Glikson recommends that in patients with a CHADS score of 0, no treatment is needed (ie, no aspirin or antithrombotic); however, patients with a CHADS score of 1 or 2 should be treated if the AF duration is \u0026gt; 24 hours, while those with a CHADS score \u0026gt; 2 should be treated if the duration is \u0026gt; 5 or 6 minutes [De Cicco AE et al. \u003Cem\u003EHeart Rhythm\u003C\/em\u003E. 2014].\u003C\/p\u003E\u003Cp id=\u0022p-22\u0022\u003EWhether CIED AF alerts might be useful in improving outcomes and whether the above approach applies to patients with paroxysmal AF detected without a CIED (ie, with routine rhythm monitoring) has yet to be determined.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/42\/16.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzok82\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzok82\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzok82\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}