title: Monitored atrial fibrillation duration predicts arterial embolic events in patients suffering from bradycardia and atrial fibrillation implanted with antitachycardia pacemakers.
abstract: OBJECTIVE
  The aim of our study was to evaluate arterial embolism (AE) occurrence rates and predictors in patients suffering from bradycardia and wearing a pacemaker with antitachycardia pacing therapies.
  
  
  BACKGROUND
  Atrial fibrillation (AF) is associated with a high incidence of AE.
  
  
  METHODS
  A total of 725 patients (360 men, age 71 +/- 11 years) were implanted with a DDDRP pacemaker (Medtronic AT500, Medtronic Inc., Minneapolis, Minnesota). At baseline 225 (31.0%) patients received antiplatelet therapy and 264 (36.4%) patients received anticoagulation agents.
  
  
  RESULTS
  Over a median 22-month follow-up (25th to 75th interquartile range 16 to 30 months), AE occurred in 14 (1.9%) patients: 7 patients suffered a nonfatal ischemic stroke (0.6% per year), 4 patients had transient ischemic attack (0.34% per year), and 3 patients had embolic complications. Among baseline patients' characteristics, multivariate logistic analysis showed that embolic events are independently associated to ischemic heart disease (7.0 odds ratio [OR], 95% confidence interval [CI] 2.3 to 21.3, p = 0.001), prior embolic event (7.3 OR, 95% CI 1.2 to 43.9, p = 0.029), diabetes (5.0 OR, 95% CI 1.2 to 15.7, p = 0.032), and hypertension (4.1 OR, 95% CI 1.1 to 15.6, p = 0.036). The risk of embolism, adjusted for known risk factors, was 3.1 times increased (95% CI 1.1 to 10.5, p = 0.044) in patients with device-detected atrial fibrillation episodes longer than one day during follow-up.
  
  
  CONCLUSIONS
  In a cohort of patients with bradycardia and AF, arterial embolism was common in patients with ischemic cardiopathy, hypertension, diabetes mellitus, and in patients with known stroke risk factors. Atrial fibrillation occurrences longer than one day were independently associated with embolic events.
authors.affiliation: Cardiology Department, Civile Hospital, Piacenza, Italy. progettovita@hotmail.com
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.forename: Michele
authors.initials: M
authors.lastname: Gulizia
authors.forename: GianLuca
authors.initials: G
authors.lastname: Botto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Renato
authors.initials: R
authors.lastname: Ricci
authors.forename: Stefano
authors.initials: S
authors.lastname: Favale
authors.forename: Francesco
authors.initials: F
authors.lastname: Zolezzi
authors.forename: Natale
authors.initials: N
authors.lastname: Di Belardino
authors.forename: Giulio
authors.initials: G
authors.lastname: Molon
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Drago
authors.forename: Giovanni Q
authors.initials: GQ
authors.lastname: Villani
authors.forename: Elena
authors.initials: E
authors.lastname: Mazzini
authors.forename: Marco
authors.initials: M
authors.lastname: Vimercati
authors.forename: Andrea
authors.initials: A
authors.lastname: Grammatico
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D001919:Bradycardia / Q000150:complications* / Q000628:therapy*; D004617:Embolism / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors