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. 2014 Feb;35(8):508-16.
doi: 10.1093/eurheartj/eht491. Epub 2013 Dec 11.

Device-detected atrial fibrillation and risk for stroke: an analysis of >10,000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices)

Giuseppe Boriani  1 , Taya V Glotzer, Massimo Santini, Teena M West, Mirko De Melis, Milan Sepsi, Maurizio Gasparini, Thorsten Lewalter, John A Camm, Daniel E Singer
Affiliations

Device-detected atrial fibrillation and risk for stroke: an analysis of >10,000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices)

Giuseppe Boriani et al. Eur Heart J. 2014 Feb.

Abstract

Objective: The aim of this study was to assess the association between maximum daily atrial fibrillation (AF) burden and risk of ischaemic stroke.

Background: Cardiac implanted electronic devices (CIEDs) enhance detection of AF, providing a comprehensive measure of AF burden.

Design, setting, and patients: A pooled analysis of individual patient data from five prospective studies was performed. Patients without permanent AF, previously implanted with CIEDs, were included if they had at least 3 months of follow-up. A total of 10 016 patients (median age 70 years) met these criteria. The risk of ischaemic stroke associated with pre-specified cut-off points of AF burden (5 min, 1, 6, 12, and 23 h, respectively) was assessed.

Results: During a median follow-up of 24 months, 43% of 10 016 patients experienced at least 1 day with at least 5 min of AF burden and for them the median time to the maximum AF burden was 6 months (inter-quartile range: 1.3-14). A Cox regression analysis adjusted for the CHADS2 score and anticoagulants at baseline demonstrated that AF burden was an independent predictor of ischaemic stroke. Among the thresholds of AF burden that we evaluated, 1 h was associated with the highest hazard ratio (HR) for ischaemic stroke, i.e. 2.11 (95% CI: 1.22-3.64, P = 0.008).

Conclusions: Device-detected AF burden is associated with an increased risk of ischaemic stroke in a relatively unselected population of CIEDs patients. This finding may add to the basis for timely and clinically appropriate decision-making on anticoagulation treatment.

Keywords: Anticoagulation; Atrial fibrillation; Implantable defibrillator; Pacemaker; Stroke.

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Figures

Figure 1
Figure 1
Atrial fibrillation burden along with time during the follow-up. Kaplan–Meier curve of patients experiencing a first day with at least 5 min of atrial fibrillation burden, among all subjects (n = 10 016).
Figure 2
Figure 2
Cumulative proportion over time of patients reaching the day with the maximum observed daily atrial fibrillation burden value during the follow-up, among patients experiencing at least 1 day of atrial fibrillation burden (n = 4287).
Figure 3
Figure 3
Distribution of patients according to maximum atrial fibrillation burden experienced during the follow-up. Stroke and transient ischaemic attack events and event rates are given in the table below the figure. Events were classified according to maximum atrial fibrillation burden experienced prior to event occurrence.
Figure 4
Figure 4
The Forest plot of unadjusted hazard ratios for (A) stroke events and (B) stroke or transient ischaemic attack events. Dotted line indicates line of unity (HR = 1.0) with dots above the line showing increased risk of stroke or (stroke or TIA); bars represent 95% CIs.
See this image and copyright information in PMC

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