What is the prevalence and what are the clinical predictors of subclinical atrial fibrillation in patients with cardiac implantable electronic devices?
Subclinical atrial fibrillation is highly prevalent (28.1%) in patients with cardiac implantable electronic devices and is strongly associated with older age and higher thromboembolic risk.
Background In recent years, attention to subclinical atrial fibrillation (SCAF), defined as the presence of atrial high-rate episodes (AHREs), in patients with cardiac implantable electronic devices (CIEDs), has gained much interest as a determinant of clinical AF and stroke risk. We aim to perform a systematic review and meta-regression of the available scientific evidence regarding the epidemiology of SCAF in patients receiving CIEDs. Methods PubMed and EMBASE were searched for all studies documenting the prevalence of AHREs in patients ( n =100 or more, <50% with history of AF) with CIEDs from inception to 20th August 2021, screened by two independent blind reviewers. This study was registered in PROSPERO: CRD42019106994. Results Among the 2614 results initially retrieved, 54 studies were included, with a total of 72,784 patients. Meta-analysis of included studies showed a pooled prevalence of SCAF of 28.1% (95%CI: 24.3-32.1%), with high heterogeneity between studies (I 2 =98%). A multivariable meta-regression was able to explain significant proportion of heterogeneity ( R 2 =61.9%, p <0.001), with age and follow-up time non-linearly, directly and independently associated with occurrence of SCAF. Older age, higher CHA 2 DS 2 -VASc score, history of AF, hypertension, CHF, and stroke/TIA were all associated with SCAF occurrence. Conclusions In this systematic review and meta-regression analysis, SCAF was frequent among CIED recipients and was non-linearly associated with age and follow-up time. Older age, higher thromboembolic risk, and several cardiovascular comorbidities were associated with presence of SCAF.
Proietti et al. (Fri,) studied this question.