Silent ischaemic brain lesions related to atrial high rate episodes in patients with cardiac implantable electronic devices.
Europace
; 17(3): 364-9, 2015 Mar.
Article
em En
| MEDLINE
| ID: mdl-25336664
ABSTRACT
AIMS:
Monitoring capabilities of cardiac implantable electronic devices have revealed that a large proportion of patients present silent atrial fibrillation (AF) detected as atrial high rate episodes (AHREs). Atrial high rate episodes >5 min have been linked to increased risk of clinical stroke, but a high proportion of ischaemic brain lesions (IBLs) could be subclinical. METHODS ANDRESULTS:
We prospectively analysed the incidence of AHRE > 5 min in 109 patients (56% men, aged 74 ± 9 years) and the presence of silent IBL on computed tomography (CT) scan. Mean CHADS2 and CHA2DS2VASc scores were 2.3 ± 1.3 and 3.9 ± 1.6, respectively. Seventy-five patients (69%) had no history of AF or stroke/transient ischaemic attack (TIA). After 12 months, 28 patients (25.7%) showed at least one AHRE. Patients with AHREs were more likely to have history of AF. Computed tomography scan showed silent IBL in 28 (25.7%). The presence of IBL was significantly related to older patients, prior history of AF or stroke/TIA, higher CHADS2 or CHA2DS2VASc scores, and the presence of AHRE. Multivariable analysis demonstrated that AHRE was an independent predictor for silent IBL in overall population [hazard ratio (HR) 3.05 (1.06-8.81; P < 0.05)] but also in patients without prior history of AF or stroke/TIA [HR 9.76 (1.76-54.07; P < 0.05)].CONCLUSION:
Cardiac implantable electronic devices can accurately detect AF as AHRE. Atrial high rate episodes were associated to a higher incidence of silent IBL on CT scan. Atrial high rate episodes represent a kind of silent AF where management recommendations are lacking despite the fact that a higher embolic risk is present.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
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Isquemia Encefálica
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Desfibriladores Implantáveis
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Acidente Vascular Cerebral
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Doenças Assintomáticas
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Dispositivos de Terapia de Ressincronização Cardíaca
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article