Abstract 12602: Silent Ischemic Brain Lesions Related to the Presence of Atrial High Rate Episodes in Patients With Cardiac Implantable Electronic Devices
Introduction: The enhanced monitoring capabilities of cardiac implantable electronic devices (CIED) have revealed that a large proportion of patients present silent atrial fibrillation (AF) detected as atrial high rate episodes (AHRE).
Hypothesis: AHRE >5min have been linked to increased risk of clinical stroke, but a high proportion of ischemic brain lesions could be subclinical and thromboembolic risk underestimated. Cranial CT-scan can detect silent lesions to determine the real risk these patients are exposed to.
Methods: We analyzed prospectively the incidence of AHRE > 5 min compatible AF in patients in sinus rhythm with dual chamber cardiac devices and the presence of ischemic brain lesions on CT-scan.
Results: 125 patients (54% men, aged 75 ± 10 years) were evaluated. Mean CHADS2 and CHA2DS2VASc scores were 2,3 ± 1,4 and 4,0 ± 1,7 respectively. History of AF was present in 27 patients (21%). After 12 months, 40 patients (32%) showed at least one AHRE >5min. Patients with AHREs were more likely to have history of AF (40% vs 13%). CT-scan showed silent ischemic brain lesions in 32 (25%). The presence of silent infarcts was significantly related to older patients, prior history of AF or stroke/TIA, higher CHADS2 or CHA2DS2VASc scores, small vessel disease and the presence of AHRE >5min. Table. Multivariable analyses demonstrated that the presence of AHRE >5min was an independent predictors for silent ischemic lesions in overall population (OR 3.39 [1.12 - 10.25; p < 0,05]) but also in patients without prior history of AF or stroke/TIA (OR 9.64 [1.86 - 50.02; p < 0,05]).
Conclusions: CIED can accurately detect AF as AHRE. AHRE were independently associated to a higher incidence of silent ischemic brain lesions on CT-scan. Moreover, patients without history of AF or stroke/TIA presenting AHRE showed a higher risk for silent ischemic brain lesions. AHRE represent a kind of silent AF where management recommendations are lacking despite the fact that a higher embolic risk is present.
Author Disclosures: J. Benezet-Mazuecos: None. J. Rubio: None. J. Iglesias: None. J. de la Vieja: None. S. Calle: None. M. Cortes: None. M. Quiñones: None. P. Sanchez-Borque: None. J. Farre: None.
- © 2014 by American Heart Association, Inc.