title: Silent atrial fibrillation in pacemaker early post-implantation period: an unintentionally provoked situation?
abstract: Atrial high-rate episodes (AHREs) compatible with silent AF detected in pacemakers (PM) are related to an increased risk of stroke and silent ischaemic brain lesions (IBL) on CT scan. AHREs soon after PM implantation could be related with the procedure itself and the prognosis might be different.
  
  
  
  We analysed the incidence of AHREs >5 min and the presence of silent IBL in 110 patients (56% men, aged 75 ± 9 year-old) with PM and no history of AF, in relation to time from implantation (≤3 months vs. >3 months) and the atrial lead fixation (LF) (active vs. passive). Mean CHADS2 and CHA2DS2VASc scores were 1.9 ± 1.2 and 3.5 ± 1.5, respectively. Time from implantation was ≤3 months in 88 patients (80%). Active LF was used in 55 patients (50%). After 24 ± 9 months, AHREs were present in 40 patients (36.4%). CT-scan showed silent IBL in 26 patients (23.6%). The presence of AHREs at 3 months was more frequent in the patients with recent PM implantation (17% vs. 4.5%, P = 0.09) and significantly related to active LF (OR 5.36, 1.43-20.07; P < 0.05). The presence of silent IBL was related to the detection of AHREs during follow up (OR 3.12, 1.29-7.97; P < 0.05) but not with AHREs at first 3 months (OR 1.58, 0.49-5.05; P = 0.44).
  
  
  
  AHREs occur frequently during the first 3 months after PM implantation and could be related with procedure itself and the use of active LF. AHREs in this period might not be related to worse outcomes and should be interpreted cautiously.
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Avenida Reyes Católicos, 2, 28040 Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Benezet-Mazuecos
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Avenida Reyes Católicos, 2, 28040 Madrid, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Iglesias
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Avenida Reyes Católicos, 2, 28040 Madrid, Spain.
authors.forename: Marcelino
authors.initials: M
authors.lastname: Cortés
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Avenida Reyes Católicos, 2, 28040 Madrid, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Rubio
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Avenida Reyes Católicos, 2, 28040 Madrid, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: de la Vieja
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Avenida Reyes Católicos, 2, 28040 Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Del Río
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Avenida Reyes Católicos, 2, 28040 Madrid, Spain.
authors.forename: Pepa
authors.initials: P
authors.lastname: Sanchez-Borque
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Avenida Reyes Católicos, 2, 28040 Madrid, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Miracle
authors.affiliation: Unidad de Arritmias. Servicio de Cardiología, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Avenida Reyes Católicos, 2, 28040 Madrid, 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 / Q000150:complications / Q000628:therapy; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017063:Outcome Assessment, Health Care; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D020521:Stroke / Q000175:diagnosis / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D014481:United States