title: Silent ischaemic brain lesions related to atrial high rate episodes in patients with cardiac implantable electronic devices.
abstract: OBJECTIVE
  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.
  
  
  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)].
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz - IDC salud, Universidad Autónoma de Madrid, Avenida Reyes Católicos 2, Madrid 28040, Spain jbenezet@fjd.es.
authors.forename: Juan
authors.initials: J
authors.lastname: Benezet-Mazuecos
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz - IDC salud, Universidad Autónoma de Madrid, Avenida Reyes Católicos 2, Madrid 28040, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Rubio
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz - IDC salud, Universidad Autónoma de Madrid, Avenida Reyes Católicos 2, Madrid 28040, Spain.
authors.forename: Marcelino
authors.initials: M
authors.lastname: Cortés
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz - IDC salud, Universidad Autónoma de Madrid, Avenida Reyes Católicos 2, Madrid 28040, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Iglesias
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz - IDC salud, Universidad Autónoma de Madrid, Avenida Reyes Católicos 2, Madrid 28040, Spain.
authors.forename: Soraya
authors.initials: S
authors.lastname: Calle
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz - IDC salud, Universidad Autónoma de Madrid, Avenida Reyes Católicos 2, Madrid 28040, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: de la Vieja
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz - IDC salud, Universidad Autónoma de Madrid, Avenida Reyes Católicos 2, Madrid 28040, Spain.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Quiñones
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz - IDC salud, Universidad Autónoma de Madrid, Avenida Reyes Católicos 2, Madrid 28040, Spain.
authors.forename: Pepa
authors.initials: P
authors.lastname: Sanchez-Borque
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz - IDC salud, Universidad Autónoma de Madrid, Avenida Reyes Católicos 2, Madrid 28040, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: de la Cruz
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz - IDC salud, Universidad Autónoma de Madrid, Avenida Reyes Católicos 2, Madrid 28040, Spain.
authors.forename: Adriana
authors.initials: A
authors.lastname: Espejo
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz - IDC salud, Universidad Autónoma de Madrid, Avenida Reyes Católicos 2, Madrid 28040, Spain.
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Farré
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed
keywords: Atrial fibrillation; Atrial high rate episodes; Cardiac electronic devices; Computed tomography.; Silent ischaemic brain lesions