Key result
Atrial high rate episodes >5 min independently predicted silent ischaemic brain lesions in patients with cardiac implantable electronic devices (HR 3.05; 95% CI 1.06-8.81; P<0.05).
Why the study?
Do atrial high rate episodes (AHRE) > 5 min predict silent ischaemic brain lesions in patients with cardiac implantable electronic devices?
Cohort (n=109)
Do atrial high rate episodes (AHRE) > 5 min predict silent ischaemic brain lesions in patients with cardiac implantable electronic devices?
Hazard Ratio: 3.05 (95% CI 1.06–8.81)
p-value: p=< 0.05
Atrial high rate episodes > 5 min detected by cardiac implantable electronic devices are independently associated with a higher incidence of silent ischaemic brain lesions on CT scan, even in patients without prior AF or stroke.
May not yet alter anticoagulation for AHRE; leaves open need for trials linking device episodes to lesion prevention.
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 AND RESULTS: 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.
No takes yet. Share an insight, caveat, or question.
Benezet‐Mazuecos et al. (2014) conducted a cohort in Cardiac implantable electronic devices (n=109). Atrial high rate episodes (AHRE) > 5 min vs. No AHRE was evaluated on Silent ischaemic brain lesions (IBL) on CT scan (HR 3.05, 95% CI 1.06-8.81, p=< 0.05). Atrial high rate episodes >5 min independently predicted silent ischaemic brain lesions in patients with cardiac implantable electronic devices (HR 3.05; 95% CI 1.06-8.81; P<0.05).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: