In the discussion of this landmark article by Dr. Gillinov and colleagues, the concept of 24-hour cardiac monitoring was brought up. Though 24-hour cardiac monitoring would give us more information on how often individuals on rate vs rhythm control are going into a-fib, how important is measuring rates of post-operative atrial fibrillation vs measuring the secondary outcomes that are caused by being in atrial-fibrillation? For example, we know that the majority of non-operative patients who suffer from a thromboembolic stroke have (or are found to have) atrial fibrillation. However, we also know that many people acquire atrial fibrillation with age and do not suffer any thromboembolic events. If, after having cardiac surgery, a patient is found via cardiac-monitoring to be in atrial fibrillation, but the patient does not feel any symptoms and therefore does not seek medical care, is the episode of atrial fibrillation still clinically significant?
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