Abstract 15187: Atrial High Rate Episodes in Pacemaker Patients and Risk of Cognitive Decline: Unmask and Prevent Atrial Fibrillation Consequences
Introduction: Atrial fibrillation (AF) has been linked with an increased risk of cognitive impairment. The mechanism is unknown, but chronic microembolism resulting in silent ischemic brain lesions (IBL) has been proposed as a potential cause. Multiple studies have shown that atrial high rate episodes (AHREs) detected in pacemakers (PM) are related to an increased risk of stroke and silent IBL on CT-scan.
Hypothesis: To evaluate the potential relation between AHREs and the presence of potential signs of cognitive decline in patients with dual-chamber PM and no history of AF or stroke.
Methods: We analyzed prospectively the incidence of AHREs > 5 min compatible with silent AF in patients that underwent a mental status examination using the Mini-Mental State Examination (MMSE). MMSE is a widely studied brief screening test that evaluates a broad range of cognitive functions.
Results: We evaluated 100 patients (57% men, aged 73 ± 9 year-old) during a mean follow-up of 19 ± 12 months. Mean CHADS2 and CHA2DS2VASc scores were 1.6 ± 0.9 and 3.1 ± 1.3, respectively. Patient’s education level included basic/no studies in 58% of the patients, medium in 27% and superior/university in 15%. AHREs were present in 27 patients (27%). CT-scan showed silent IBL in 19 patients (19%). Mean MMSE score was 27.6 ± 2.7. Nine patients (9%) presented a MMSE score ≤ 23 compatible with dementia and 64 patients (64%) presented completely normal MMSE scores (30 points). Normal MMSE was significantly less frequent in women (52% vs 81%, p=0.003), smokers (46% vs 77%, p=0.002) and patients presenting AHREs > 5 min during the follow-up (19% vs 41%, p=0.038). There were no differences related to the presence of silent IBL or the educational level. Multivariate analysis showed that the presence of AHREs during follow up was an independent predictor for lower results in the MMSE (OR 1.58, 2.27 - 10.55; p=0.007).
Conclusions: AHREs compatible with silent AF are really prevalent in patients receiving PM and have been associated to worse outcomes. Our data suggest that AHREs might be also related to cognitive decline. Future studies should clarify this potential risk. Identification of silent AF is crucial to avoid thromboembolic complications and might also prevent cognitive deterioration in these patients.
Author Disclosures: J. Benezet-Mazuecos: None. J. Iglesias: None. M. Cortes: None. J. de la Vieja: None. E. Serrano: None. P. Sanchez-Borque: None. A. Miracle: None. J. Rubio: None. J. Farre: None.
- © 2016 by American Heart Association, Inc.