Occurrence of Subclinical Atrial Fibrillation in the Follow-up of Patients with Cardiac Pacemakers
Keywords:Artificial pacemaker, Atrial fibrillation, Cardiac arrhythmias, Hospital outpatient clinic
Objective: Cardiac pacemaker records atrial fibrillation (AF). This condition can cause serious hemodynamic consequences to patients, who should be assisted by a cardiologist. This study aimed to document and investigate, in a tertiary hospital, the prevalence of subclinical AF in patients with a cardiac pacemaker. Methods: Between July 2015 and April 2016, 196 patients with pacemakers were attended on an outpatient basis. Of these, 60 had cardiac arrhythmias recorded by the pacemaker and were invited to participate in the study. Data collection was done through a structured interview containing four questions: gender, age, follow-up with cardiologist and use of anticoagulants. Results: Subclinical AF was recorded in 35 (17.8%) of the total of 196 patients. Of these 35, 16 (45.7%) did not follow a regular cardiology service and 29 (82.8%) did not use anticoagulant medication. No statistically significant relationships were found between age, follow up with a cardiologist, and presence or absence of subclinical AF in the patients studied. Conclusion: A significant portion of outpatient patients with pacemakers have AF recorded by the device. However, although essential, almost half of these do not proceed with the clinical follow-up with cardiologist and less than a fifth with AF makes use of anticoagulant therapy.
Ball J, Carrington MJ, McMurray JJV, Stewart S. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol. 2013;167(5):1807-24. https://doi.org/10.1016/j.ijcard.2012.12.093
Rahman F, Kwan GF, Benjamin EJ. Global epidemiology of atrial fibrillation. Nat Rev Cardiol. 2014;11(11):639-54.
Israel CW, Grönefeld G, Ehrlich JR, Li Y-G, Hohnloser SH. Long-term risk of recurrent atrial fibrillation as
documented by an implantable monitoring device. J Am Coll Cardiol. 2004;43(1):47-52. https://doi.org/10.1016/j.
Camm AJ, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369-429. https://doi.org/10.1093/eurheartj/ehq278
Healey JS, Martin JL, Duncan A, Connolly SJ, Ha AH, Morillo CA, et al. Pacemaker-detected atrial fibrillation in patients with pacemakers: prevalence, predictors, and current use of oral anticoagulation. Can J Cardiol. 2013;29(2):224-8. https://doi.org/10.1016/j.cjca.2012.08.019
Yedlapati N, Fisher JD. Pacemaker diagnostics in atrial fibrillation: limited usefulness for therapy initiation
in a pacemaker practice. Pacing Clin Electrophysiol. 2014;37(9):1189-97. https://doi.org/10.1111/pace.12392
Healey JS, Connolly SJ, Gold MR, Israel CW, Van Gelder IC, Capucci A, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012;366(2):120-9. https://doi.org/10.1056/NEJMoa1105575
January CT, Wann LS, Alpert JS, Calkins H, Cleveland Jr JC, Cigarroa JE, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive summary. J Am Coll Cardiol. 2014;(212):1-57. https://doi.org/10.1161/CIR.0000000000000041
Cabrera S, Mercé J, Castro R de, Aguirre C, Carmona A, Pinedo M, et al. Pacemaker clinic: An opportunity to detect silent atrial fibrillation and improve antithrombotic treatment. Europace. 2011;13(11):1574-9. https://doi.org/10.1093/europace/eur160
Schnabel RB, Sullivan LM, Levy D, Pencina MJ, Massaro JM, D’Agostino RB, et al. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet. 2009;373(9665):739-45. https://doi.org/10.1016/S0140-6736(09)60443-8
Mabo P, Victor F, Bazin P, Ahres S, Babuty D, Costa A da, et al. A randomized trial of long-term remote monitoring of pacemaker recipients (The COMPAS trial). Eur Heart J. 2012;33(9):1105-11. https://doi.org/10.1093/eurheartj/ehr419
Glotzer TV, Daoud EG, Wyse DG, Singer DE, Ezekowitz MD, Hilker C, et al. The relationship between daily
atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk the trends study. Circ Arrhythmia Electrophysiol. 2009;2(5):474-80. https://doi.org/10.1161/CIRCEP.109.849638
Defaye P, Leclercq J-F, Guilleman D, Scanu P, Hazard J-R, Fatemi M, et al. Contributions of high resolution electrograms memorized by DDDR pacemakers in the interpretation of arrhythmic events. Pacing Clin Electrophysiol. 2003;26 (1 Pt 2):214-20. https://doi.org/10.1046/j.1460-9592.2003.00019.x
Kaufman ES, Israel CW, Nair GM, Armaganijan L, Divakaramenon S, Mairesse GH, et al. Positive predictive
value of device-detected atrial high-rate episodes at different rates and durations: an analysis from ASSERT.
Hear Rhythm. 2012;9(8):1241-6. https://doi.org/10.1016/j.hrthm.2012.03.017
Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2015;36(41):2793-867. https://doi.org/10.1093/eurheartj/ehv316
Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia. Circulation. 2015;64(21). https://doi.org/10.1161/CIR.0000000000000311