Atrial fibrillation and stroke risk factors in patients with cardiac implantable electronic devices

Abstract

Purpose. Determination the proportion and burden of new-onset atrial fibrillation (AF) in patients with cardiac implantable electronic devices (CIED) and without prior AF and assessing the incidence of risk factors for stroke in patients with AF.Methods. The medical history of 111 patients with CIED with remote monitoring function were analyzed. AF diagnosed by the device was interpreted by an arrhythmologist and cases of significant AF were selected. The group of patients with and without AF was compared for several factors. To clarify the influence of risk factors on the duration of AF, all AF cases were divided into 3 categories depending on the AF burden per day. The first group included patients with an AF burden per day of 0.1% or less (n=10, (45.5%)), the second - from 0.3% to 12.2% (n=7, (31.8%)), and the third group - with 100% (n=5, (22.7%)). Patients with a burden of 0.2%, 12.3-99.9% were absent.Results. Newly diagnosed AF was registered in 19.8% of cases. The risk of stroke among these patients was high - 2 [1; 3] points on the CHA2 DS2 -VASc for men, and 3 [2,75; 3,75] points for women. Hypertension of 2 and 3 degrees was recorded in all patients in the group with an AF burden of 100% per day. That significantly differed from the other 2 groups (p=0.043). In the group with an AF burden of 100%, the levels of NT-proBNP, D-dimer, and creatinine were significantly higher than in the other groups (p=0.037, p=0.031 and p=0.036, respectively). When analyzing the dependence of creatinine level on the presence of AF, the area under the ROC-curve was 0.653 with 95% confidence interval 0.528-0.779 (p=0.017). The proportion of right ventricular pacing in patients with ICD was higher in the group of patients with AF.Conclusion. AF occurs in 1/5 of patients with CIED. All patients with AF were potential candidates for anticoagulation due to their high risk of stroke. The daily burden of AF is positively correlated with the presence and degree of hypertension, as well as with markers of renal dysfunction, chronic heart failure, and thrombosis. Elevated creatinine levels are a predictor of AF.