Temporal Relationship Between Subclinical Atrial Fibrillation and Embolic Events

被引:543
作者
Brambatti, Michela [1 ,2 ]
Connolly, Stuart J. [1 ]
Gold, Michael R. [3 ]
Morillo, Carlos A. [1 ]
Capucci, Alessandro [2 ]
Muto, Carmine [4 ]
Lau, Chu P. [5 ]
Van Gelder, Isabelle C. [6 ]
Hohnloser, Stefan H. [7 ]
Carlson, Mark [8 ]
Fain, Eric
Nakamya, Juliet [1 ]
Mairesse, Georges H. [9 ]
Halytska, Marta [1 ]
Deng, Wei Q. [1 ]
Israel, Carsten W. [10 ]
Healey, Jeff S. [1 ]
机构
[1] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON L8L 2X2, Canada
[2] Univ Politecn Marche, Clin Cardiol, Ancona, Italy
[3] Med Univ S Carolina, Charleston, SC USA
[4] Loreto Mare, Dept Cardiol, Naples, Italy
[5] Univ Hong Kong, Queen Mary Hosp, Dept Med, Hong Kong, Hong Kong, Peoples R China
[6] Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands
[7] Goethe Univ Frankfurt, D-60054 Frankfurt, Germany
[8] St Jude Med, Sylmar, CA USA
[9] Clin Sud Luxembourg, Arlon, Belgium
[10] Evangel Hosp Bielefeld, Dept Med, Div Cardiol, Bielefeld, Germany
关键词
arrhythmia; pacemaker; stroke; ORAL ANTICOAGULATION; SUBGROUP ANALYSIS; RISK FACTOR; STROKE; TRIAL; FLUTTER; RHYTHM; THROMBOEMBOLISM; CARDIOVERSION; PREVALENCE;
D O I
10.1161/CIRCULATIONAHA.113.007825
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:2094 / 2099
页数:6
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