Temporal relationship between subclinical atrial fibrillation and embolic events
- PMID: 24633881
- DOI: 10.1161/CIRCULATIONAHA.113.007825
Temporal relationship between subclinical atrial fibrillation and embolic events
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.
Keywords: arrhythmia; pacemaker; stroke.
© 2014 American Heart Association, Inc.
Comment in
-
Letter by Haft regarding article, "Temporal relationship between subclinical atrial fibrillation and embolic events".Circulation. 2015 Feb 3;131(5):e336. doi: 10.1161/CIRCULATIONAHA.114.011693. Circulation. 2015. PMID: 25645617 No abstract available.
-
Response to letter regarding article "Temporal relationship between subclinical atrial fibrillation and embolic events".Circulation. 2015 Feb 3;131(5):e337-8. doi: 10.1161/CIRCULATIONAHA.114.012885. Circulation. 2015. PMID: 25645618 No abstract available.
Similar articles
-
Progression of Device-Detected Subclinical Atrial Fibrillation and the Risk of Heart Failure.J Am Coll Cardiol. 2018 Jun 12;71(23):2603-2611. doi: 10.1016/j.jacc.2018.03.519. J Am Coll Cardiol. 2018. PMID: 29880119 Clinical Trial.
-
Duration of device-detected subclinical atrial fibrillation and occurrence of stroke in ASSERT.Eur Heart J. 2017 May 1;38(17):1339-1344. doi: 10.1093/eurheartj/ehx042. Eur Heart J. 2017. PMID: 28329139
-
Stroke type and severity in patients with subclinical atrial fibrillation: An analysis from the Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT).Am Heart J. 2018 Jul;201:160-163. doi: 10.1016/j.ahj.2018.03.027. Epub 2018 Apr 18. Am Heart J. 2018. PMID: 29764671 Clinical Trial.
-
Subclinical atrial fibrillation and stroke: insights from continuous monitoring by implanted cardiac electronic devices.Europace. 2015 Oct;17 Suppl 2:ii40-6. doi: 10.1093/europace/euv235. Europace. 2015. PMID: 26842114 Review.
-
Subclinical Atrial Fibrillation and Risk of Stroke: Past, Present and Future.Medicina (Kaunas). 2019 Sep 20;55(10):611. doi: 10.3390/medicina55100611. Medicina (Kaunas). 2019. PMID: 31547078 Free PMC article. Review.
Cited by
-
Association of left pulmonary vein trunk and subclinical atrial fibrillation in patients with cardiac implantable electronic device.Heart Vessels. 2024 Jun 1. doi: 10.1007/s00380-024-02423-4. Online ahead of print. Heart Vessels. 2024. PMID: 38822844
-
Contemporary Advances in Cardiac Remote Monitoring: A Comprehensive, Updated Mini-Review.Medicina (Kaunas). 2024 May 16;60(5):819. doi: 10.3390/medicina60050819. Medicina (Kaunas). 2024. PMID: 38793002 Free PMC article. Review.
-
Predictors of atrial fibrillation after embolic stroke of undetermined source in patients with implantable loop recorders.Neurol Sci. 2024 Apr 25. doi: 10.1007/s10072-024-07548-y. Online ahead of print. Neurol Sci. 2024. PMID: 38664303
-
Age-Dependent Detection of Atrial Fibrillation with Implantable Cardiac Monitors in Patients with Cryptogenic Stroke.TH Open. 2024 Apr 17;8(2):e202-e208. doi: 10.1055/s-0044-1786015. eCollection 2024 Apr. TH Open. 2024. PMID: 38633729 Free PMC article.
-
2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.J Interv Card Electrophysiol. 2024 Aug;67(5):921-1072. doi: 10.1007/s10840-024-01771-5. J Interv Card Electrophysiol. 2024. PMID: 38609733 Review.
Publication types
MeSH terms
Associated data
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical