ARTESiA: Stroke risk unaffected by subclinical atrial fibrillation duration

Device-detected subclinical atrial fibrillation (AF) duration is not a risk factor for stroke or systemic embolism in patients with a history of subclinical AF, suggests an analysis based on the ARTESiA trial.

ARTESiA (NCT01938248) was a multicentre, double-blind trial comparing apixaban with aspirin in participants with a device-detected history of subclinical AF lasting 6 minutes to 24 hours [1]. Dr William McIntyre (Population Health Research Institute, Canada) presented a prespecified analysis that evaluated the link between subclinical AF longest duration/frequency and overall risk of stroke/systemic embolism on one hand, and the stroke reduction effect of apixaban on the other [2]. For this analysis, participants were only included if their subclinical AF episode was observed in the 6 months prior to enrollment.

The absolute risk of stroke/systemic embolism was approximately 1%/year in all 3 subgroups with a longest subclinical AF  episode duration of <1 h (reference), 1–6 h (adjusted HR 1.02; 95% CI 0.85–1.90), and >6h (adjusted HR 1.02; 95% CI 0.63–1.66). Similarly, the longest subclinical AF episode duration did not impact the effect of apixaban versus aspirin in preventing stroke/systemic embolism (P=0.097 for trend).

When assessing the effect of the number of episodes, no episodes in the previous 6 months versus any subclinical AF episodes were associated with a decrease in stroke/systemic embolism risk (adjusted HR 0.48; 95% CI 0.27–0.85). However, no statistically significant interaction was seen between the presence of episodes and the treatment effect of apixaban (P=0.108 for interaction).

“In patients with device-detected subclinical AF whose longest episode lasts between 6 min and 24 h, subclinical AF duration does not provide information that is helpful for risk stratification of stroke,” concluded Dr McIntyre (Population Health Research Institute, ON, Canada).

1. 
   
   1. Healey JS, et al. N Engl J Med 2024;390(2):107-117.
   2. McIntyre W, et al. A Risk of stroke or systemic embolism according to baseline frequency and duration of subclinical atrial fibrillation: Insights from the ARTESiA trial. Late-Breaking Science: devices. EHRA Congress 2024, 7–9 April, Berlin, Germany.

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Posted on 29 April 202429 April 2024