Temporal Relationship Between Subclinical Atrial Fibrillation and Embolic Events

作者：Michela Brambatti, Stuart J. Connolly, Michael R. Gold, Carlos A. Morillo, Alessandro Capucci, Carmine Muto, Chu‐Pak Lau, Isabelle C. Van Gelder, Stefan H. Hohnloser, Mark D. Carlson, Eric Fain, Juliet Nakamya, Georges H. Mairesse, Marta Halytska, Wei Q. Deng, Carsten W. Israel, Jeff S. Healey · 发表于：Circulation · 年份：2014 · DOI：10.1161/circulationaha.113.007825 · 被引用次数：674 · 研究领域：Atrial Fibrillation Management and Outcomes、Cardiac pacing and defibrillation studies、Cardiac Arrhythmias and Treatments

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 da...