CLINICAL RESEARCH: CARDIAC RHYTHM DISORDER
Monitored Atrial Fibrillation Duration Predicts Arterial Embolic Events in Patients Suffering From Bradycardia and Atrial Fibrillation Implanted With Antitachycardia Pacemakers
Alessandro Capucci, MD*,*,
Massimo Santini, MD ,
Luigi Padeletti, MD ,
Michele Gulizia, MD ,
GianLuca Botto, MD||,
Giuseppe Boriani, MD¶,
Renato Ricci, MD,
Stefano Favale, MD#,
Francesco Zolezzi, MD**,
Natale Di Belardino, MD,
Giulio Molon, MD,
Fabrizio Drago, MD,
Giovanni Q. Villani, MD*,
Elena Mazzini, MS||||,
Marco Vimercati, MS||||,
Andrea Grammatico, PhD|||| on behalf of the Italian AT500 Registry Investigators
* Cardiology Department, Civile Hospital, Piacenza, Italy
Cardiology Department, S. Filippo Neri Hospital, Rome, Italy
Cardiology Department, Clinica Medica, University of Florence, Florence, Italy
Cardiology Department, San Luigi-S. Currò Hospital, Catania, Italy
|| Cardiology Department, S. Anna Hospital, Como, Italy
¶ Institute of Cardiology, University of Bologna, Bologna, Italy
# Cardiology Department, Policlinico Hospital, Bari, Italy
** Cardiology Department, Civile Hospital, Vigevano, Italy
Cardiology Department, Civile Hospital, Velletri, Italy
Cardiology Department, S. Cuore Hospital, Negrar, Italy
Cardiology Department, Bambino Gesù Hospital, Rome, Italy
|||| Clinical Department, Medtronic Italy, Milan, Italy
Manuscript received April 29, 2005;
revised manuscript received June 28, 2005,
accepted July 4, 2005.
* Reprint requests and correspondence: Dr. Alessandro Capucci, Institute of Cardiology, Civile Hospital, Divisione di Cardiologia, Ospedale "Guglielmo da Saliceto," Via Taverna 49, 29100 Piacenza, Italy (Email: progettovita{at}hotmail.com).
OBJECTIVES: 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.
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Abbreviations and Acronyms
| | AF = atrial fibrillation | | CI = confidence interval | | CTOPP = Canadian Trial Of Physiologic Pacing | | IQR = interquartile range | | MOST = Mode Selection Trial | | OR = odds ratio | | TIA = transient ischemic attack |
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