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Pacemaker-detected atrial fibrillation burden and risk of ischemic stroke or thromboembolic events-A cohort study

Song-Yun Chu1, Jie Jiang1, Yu-Ling Wang1

  • 1Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District,100034, Beijing, China.

Heart & Lung : the Journal of Critical Care
|August 5, 2019
PubMed

Insights

Atrial fibrillation (AF) burden detected by pacemakers increases thromboembolism risk in patients with similar CHA₂DS₂-VASc scores. This finding suggests AF burden should be considered alongside existing stroke risk assessments.

Area of Science:

  • Cardiology
  • Medical Technology

Background:

  • Atrial fibrillation (AF) burden is a potential risk factor for systemic embolism.
  • Current stroke risk scores like CHA₂DS₂-VASc do not incorporate AF burden due to assessment difficulties.
  • Dual-chamber pacemakers offer a method to quantify AF incidence and duration.

Purpose of the Study:

  • To evaluate the association between AF burden and thromboembolism in patients with dual-chamber pacemakers.
  • To determine if pacemaker-detected AF burden predicts thromboembolic events independently of CHA₂DS₂-VASc scores.

Main Methods:

  • Retrospective cohort study of patients with dual-chamber pacemakers (October 2003 - May 2017).
  • Exclusion of patients with prior thromboembolism or on anticoagulants.
  • Propensity score matching and multivariate regression to analyze AF burden and thromboembolic outcomes.

Main Results:

  • Patients with thromboembolism had higher CHA₂DS₂-VASc scores but not initially higher AF burden.
  • In propensity score-matched cohorts, higher AF burden was linked to increased thromboembolism risk.
  • Pacemaker-detected AF episodes >6 minutes significantly predicted future stroke or thromboembolism.

Conclusions:

  • Pacemaker-detected AF burden is associated with an elevated risk of thromboembolism in patients with dual-chamber pacemakers, even with comparable CHA₂DS₂-VASc scores.
  • Further research is needed to integrate AF burden into risk stratification models for guiding anticoagulation therapy.
Abstract

Keywords:
Atrial fibrillation burdenDual-chamber pacemakerEmbolismStroke

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