title: Silent brain infarcts in high blood pressure patients with cardiac implantable electronic devices: unmasking silent atrial fibrillation.
abstract: BACKGROUND
  Hypertensive patients present a higher risk for developing atrial fibrillation and its complications. Cardiac implantable electronic devices (CIEDs) have shown reliable atrial fibrillation detection as atrial high-rate episodes (AHREs). The presence of AHRE more than 5 min has been related to increased risk of stroke, but a high proportion of ischemic brain lesions (IBLs) could be subclinical and thromboembolic risk underestimated.
  
  
  METHODS
  We included hypertensive patients with CIED and we analyzed the incidence of AHRE and the presence of IBL on computed tomography (CT) scan.
  
  
  RESULTS
  One hundred and twenty-three patients (57% men) aged 77 ± 8 years were evaluated during a mean follow-up of 15 ± 9 months. AHREs were documented in 46 patients (37%). Cranial CT scan showed silent IBL in 34 patients (27%). Univariate analysis showed that age, CHADS2 and CHADS2VA2Sc scores, history of prior stroke/ transient ischemic attack and the presence of AHRE were significantly related to higher risk for IBL on CT scan (P < 0.05). Multivariate analysis showed that the presence of AHRE more than 5 min [odds ratio 3.05 (1.19-7.81; P < 0.05)] was an independent predictor of IBL.
  
  
  CONCLUSIONS
  Silent atrial fibrillation detected by CIED as AHRE is really prevalent in hypertensive patients. AHREs were independently associated with a higher incidence of silent IBL on CT scan.
authors.affiliation: Cardiology Department, Hospital Universitario Fundación Jiménez Díaz- Quiron salud, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Benezet-Mazuecos
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Iglesias
authors.forename: Marcelino
authors.initials: M
authors.lastname: Cortes
authors.forename: Juan José De La
authors.initials: JJ
authors.lastname: Vieja
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Rubio
authors.forename: Pepa
authors.initials: P
authors.lastname: Sanchez-Borque
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Farre
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000150:complications; D008297:Male; D010138:Pacemaker, Artificial; D012307:Risk Factors; D020521:Stroke / Q000150:complications; D014057:Tomography, X-Ray Computed