Temporal Relationship Between Subclinical Atrial Fibrillation and Embolic Events
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Open Access
- 27 May 2014
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 129 (21), 2094-2099
- https://doi.org/10.1161/circulationaha.113.007825
Abstract
Background—Among patients with implantable pacemakers and defibrillators, subclinical atrial fibrillation (SCAF) is associated with an increased risk of stroke; however, there is limited understanding of their temporal relationship. Methods and Results—The Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT) enrolled 2580 pacemaker and defibrillator patients aged ≥65 years with a history of hypertension but without a history of atrial fibrillation. Pacemakers and implantable cardioverter-defibrillators precisely logged the time and duration of all episodes of SCAF and recorded electrograms that were adjudicated by experts. We examined the temporal relationship between SCAF >6 minutes in duration and stroke or systemic embolism. Of 51 patients who experienced stroke or systemic embolism during follow-up, 26 (51%) had SCAF. In 18 patients (35%), SCAF was detected before stroke or systemic embolism. However, only 4 patients (8%) had SCAF detected within 30 days before stroke or systemic embolism, and only 1 of these 4 patients was experiencing SCAF at the time of the stroke. In the 14 patients with SCAF detected >30 days before stroke or systemic embolism, the most recent episode occurred at a median interval of 339 days (25th to 75th percentile, 211–619) earlier. Eight patients (16%) had SCAF detected only after their stroke, despite continuous monitoring for a median duration of 228 days (25th to 75th percentile, 202–719) before their event. Conclusions—Although SCAF is associated with an increased risk of stroke and embolism, very few patients had SCAF in the month before their event. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00256152.This publication has 30 references indexed in Scilit:
- Pacemaker-Detected Atrial Fibrillation in Patients With Pacemakers: Prevalence, Predictors, and Current Use of Oral AnticoagulationCanadian Journal of Cardiology, 2013
- Inflammation in Atrial FibrillationJournal of the American College of Cardiology, 2012
- Antithrombotic Therapy for Atrial Fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice GuidelinesSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2012
- Incidence of Newly Detected Atrial Arrhythmias via Implantable Devices in Patients With a History of Thromboembolic EventsStroke, 2010
- Multicenter randomized study of anticoagulation guided by remote rhythm monitoring in patients with implantable cardioverter-defibrillator and CRT-D devices: Rationale, design, and clinical characteristics of the initially enrolled cohort: The IMPACT studyAmerican Heart Journal, 2009
- Risks and Benefits of Oral Anticoagulation Compared With Clopidogrel Plus Aspirin in Patients With Atrial Fibrillation According to Stroke RiskStroke, 2008
- Noninvasive Cardiac Monitoring for Detecting Paroxysmal Atrial Fibrillation or Flutter After Acute Ischemic StrokeStroke, 2007
- ASymptomatic atrial fibrillation and Stroke Evaluation in pacemaker patients and the atrial fibrillation Reduction atrial pacing Trial (ASSERT)American Heart Journal, 2006
- Asymptomatic atrial fibrillation: Demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) studyAmerican Heart Journal, 2005
- Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.Stroke, 1991