{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T18:23:03Z","timestamp":1788546183844,"version":"build-2803163510"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2023,4,1]]},"abstract":"Importance<\/jats:title>There is increasing interest in heart rhythm monitoring and technologies to detect subclinical atrial fibrillation (AF), which may lead to incidental diagnosis of bradyarrhythmias.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess bradyarrhythmia prevalence and prognostic significance in persons screened for AF using implantable loop recorder (ILR) compared with unscreened persons.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This was a post hoc analysis of the Implantable Loop Recorder Detection of Atrial Fibrillation to Prevent Stroke (LOOP) randomized clinical trial, which took place in 4 sites in Denmark. Participants were 70 years or older without known AF but diagnosed with at least 1 of the following: hypertension, diabetes, heart failure, or prior stroke. Participants were recruited by letter invitation between January 31, 2014, and May 17, 2016. The median (IQR) follow-up period was 65 (59-70) months. Analysis took place between February and June 2022.<\/jats:p><\/jats:sec>Interventions<\/jats:title>ILR screening for AF with treatment of any bradyarrhythmia left to the discretion of the treating physician (ILR group) vs usual care (control group).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Adjudicated bradyarrhythmia episodes, pacemaker implantation, syncope, and sudden cardiovascular death.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 6004 participants were randomized (mean [SD] age, 75 [4.1] years; 2837 [47.3%] female; 5444 [90.7%] with hypertension; 1224 [20.4%] with prior syncope), 4503 to control and 1501 to ILR. Bradyarrhythmia was diagnosed in 172 participants (3.8%) in the control group vs 312 participants (20.8%) in the ILR group (hazard ratio [HR], 6.21 [95% CI, 5.15-7.48]; P<\/jats:italic>\u2009&amp;lt;\u2009.001), and these were asymptomatic in 41 participants (23.8%) vs 249 participants (79.8%), respectively. The most common bradyarrhythmia was sinus node dysfunction followed by high-grade atrioventricular block. Risk factors for bradyarrhythmia included higher age, male sex, and prior syncope. A pacemaker was implanted in 132 participants (2.9%) vs 67 (4.5%) (HR, 1.53 [95% CI, 1.14-2.06]; P<\/jats:italic>\u2009&amp;lt;\u2009.001), syncope occurred in 120 (2.7%) vs 33 (2.2%) (HR, 0.83 [95% CI, 0.56-1.22]; P<\/jats:italic>\u2009=\u2009.34), and sudden cardiovascular death occurred in 49 (1.1%) vs 18 (1.2%) (HR, 1.11 [95% CI, 0.64-1.90]; P<\/jats:italic>\u2009=\u2009.71) in the control and ILR groups, respectively. Bradyarrhythmias were associated with subsequent syncope, cardiovascular death, and all-cause death, with no interaction between bradyarrhythmia and randomization group.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>More than 1 in 5 persons older than 70 years with cardiovascular risk factors can be diagnosed with bradyarrhythmias when long-term continous monitoring for AF is applied. In this study, ILR screening led to a 6-fold increase in bradyarrhythmia diagnoses and a significant increase in pacemaker implantations compared with usual care but no change in the risk of syncope or sudden death.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2022.5526","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T16:04:17Z","timestamp":1676477057000},"page":"326","source":"Crossref","is-referenced-by-count":28,"title":["Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care"],"prefix":"10.1001","volume":"8","author":[{"given":"S\u00f8ren Z\u00f6ga","family":"Diederichsen","sequence":"first","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2013Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas Yixi","family":"Xing","sequence":"additional","affiliation":[{"name":"Department of Cardiology, 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Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren","family":"H\u00f8jberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2013Bispebjerg, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derk","family":"Krieger","sequence":"additional","affiliation":[{"name":"Stroke Unit, Mediclinic City Hospital, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Brandes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, Odense, Denmark"},{"name":"Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"},{"name":"Department of Internal Medicine\u2013Cardiology, University Hospital of Southern Denmark\u2013Esbjerg, Esbjerg, 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