Response by Lip to Letter Regarding Article, “How to Manage Occult Atrial Fibrillation Detected on Long-Term Monitoring”
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I thank Hess et al for the comments on the Clinician Update article.1 I agree that challenges remain as to being absolutely sure on the actual risk associated with atrial fibrillation (AF) burden (in terms of duration and number of arrhythmia episodes) or device-detected subclinical atrial tachyarrhythmias (where most, but not necessarily all, are AF). Ongoing randomized trials are exploring these aspects, particularly with the availability of non–vitamin K antagonist oral anticoagulants that offer relative efficacy, safety, and convenience in comparison with warfarin.
However, what may be a low arrhythmia burden in a particular monitoring period may not necessarily be a low burden …