Monitored atrial fibrillation duration predicts arterial embolic events in patients suffering from bradycardia and atrial fibrillation implanted with antitachycardia pacemakers.
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.
Capucci
Alessandro
A
Cardiology Department, Civile Hospital, Piacenza, Italy. progettovita@hotmail.com
Santini
Massimo
M
Padeletti
Luigi
L
Gulizia
Michele
M
Botto
GianLuca
G
Boriani
Giuseppe
G
Ricci
Renato
R
Favale
Stefano
S
Zolezzi
Francesco
F
Di Belardino
Natale
N
Molon
Giulio
G
Drago
Fabrizio
F
Villani
Giovanni Q
GQ
Mazzini
Elena
E
Vimercati
Marco
M
Grammatico
Andrea
A
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