Though anticoagulation is highly effective at preventing AF-related strokes, chronic anticoagulation exposes patients to a non-trivial risk of anticoagulant-induced hemorrhage. Major developments in both long-term continuous electrocardiogram (ECG) monitoring and oral anticoagulation, however, hold promise that continuous chronic anticoagulation may be avoidable in some subsets of AF patients who otherwise meet guideline criteria for lifelong anticoagulation.
The use of a small, leadless subcutaneous insertable cardiac monitors (ICM) with remote data transmission capabilities (Reveal XT™ and Reveal LINQ™, Medtronic Inc.) provide the ability to remotely and continuously evaluate a patient for AF recurrences. In addition, the novel oral anticoagulants (NOACS) (dabigatran, rivaroxaban, and apixaban) result in rapid onset anticoagulation within hours of a single oral dose. Together, these developments allow for continuous AF monitoring with targeted anticoagulation based on AF recurrence.
The Rhythm Evaluation for AntiCoagulaTion with COntinuous Monitoring (REACT.COM) pilot study (ClinicalTrials.gov NCT01706146) is designed to assess the feasibility of "pill-in-the-pocket" anticoagulation using daily remote transmissions from an ICM.