Key role of long-duration cardiac rhythm monitoring in patients with sickle cell disease with atrial hyperexcitability

Atrial hyperexcitability (AH) is common in adult patients with sickle cell anemia (SCA) and strongly linked to cryptogenic stroke history.However, the role of long-duration rhythm monitoring (LDRM) in identifying sustained and potentially thromboembolic arrhythmias remains unclear.We performed an ancillary analysis within the DREPACOEUR registry to evaluate the efficacy of LDRM (14-days at least) in detecting sustained atrial fibrillation (AF) in adult SCA patients with AH on 24-hour Holter monitoring but no prior AF or stroke history.SCA patients undergoing LDRM for other indications were used as controls.In total, 23 patients (median age 53 [49; 61] years; 48% male) were included, 13 (57%) with AH and 10 (43%) controls.The prevalence of AF detected by LDRM was 26%, with a striking significant higher rate in patients with AH on 24h-Holter monitoring (46%) versus controls (0%; p=0.01).Within the AH group, sustained AF was associated with younger age and more severe hemolytic anemia.These findings reveal a high AF prevalence in SCA patients with AH and underscore the importance of systematic LDRM in this population.Proactive rhythm monitoring may facilitate early therapy and reduce stroke risk in these vulnerable patients.