Anticoagulation Management in Patients with Pacemaker-Detected Atrial Fibrillation
Keywords:atrial fibrillation, pacemaker, anticoagulants, thrombo-embolic events, asymptomatic
INTRODUCTION: In patients with an implanted pacemaker, asymptomatic atrial fibrillation (AF) is associated with an increased risk of thrombo-embolic complications. There is still no consensus which duration of episodes of atrial fibrillation should be taken as an indicator for inclusion of oral anticoagulation therapy (OAC).
MATERIAL AND METHODS: A total of 104 patients who had no AF episodes in the past and have an indication for permanent pacing were included in the study.
RESULTS: During an average follow-up of 18 months, 33 of the patients developed episodes of AF. Inclusion of OAC was performed in 17 patients, in whom AF was recorded, although in all patients CHA2DS2-VASc score was â‰¥ 1. The inclusion of OAC showed a statistically significant correlation with increasing duration of episodes of AF (r = 0.502, p = 0.003). During the follow-up period none of the patients developed thrombo-embolic complication.CONCLUSION: Considering that our group of patients had no thrombo-embolic events, we could conclude that dividing the AF episodes in less than 1% in 24 hours and longer than 1% within 24 hours could be an indicator for decision-making to include OAK if the CHA2DS2-VASc score is â‰¥ 1.
Plum Analytics Artifact Widget Block
The Task Force for the Management of Atrial Fibrillation of the European Society of cardiology (ESC). Guidelines for the management of atrial fibrillation. Eur Heart J. 2010; 31: 2369â€“2429. http://dx.doi.org/10.1093/eurheartj/ehq278 PMid:20802247
2012 focused update of the ESC Guidelines for the management of atrial fibrillation An update of the 2010 ESC Guidelines for the management of atrial fibrillation Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012; 33: 2719â€“2747. http://dx.doi.org/10.1093/eurheartj/ehs253 PMid:22922413
Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of anti-thrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med. 1994; 154: 1449â€“57. http://dx.doi.org/10.1001/archinte.1994.00420130036007
Laupacis A, Albers G, Dalen J, et al. Antithrombotic therapy in atrial fibrillation. Chest. 1998; 114: 579Sâ€“89S. http://dx.doi.org/10.1378/chest.114.5_Supplement.579S PMid:9822064
Savelieva I, Camm AJ. Clinical relevance of silent atrial fibrillation: prevalence, prognosis, quality of life, and management. J Interv Card Electrophysiol. 2000; 4:369-82. http://dx.doi.org/10.1023/A:1009823001707 PMid:10936003
Rizos T, Wagner A, Jenetzky E et al. Paroxysmal atrial fibrillation is more prevalent than persistent atrial fibrillation in acute stroke and transient ischemic attack patients. Cerebrovasc Dis. 2011; 32:276-82. PMid:21893980
Glotzer TV, Hellkamp AS, Zimmerman J, et al. Atrial high rate episodes detected by pacemaker diagnostics predicts death and stroke: report of the atrial diagnostic ancillary study of the Mode Selection Trial (MOST). Circulation. 2003;107:1614-9. http://dx.doi.org/10.1161/01.CIR.0000057981.70380.45 PMid:12668495
Strickberger SA, Ip J, Saksena S, Curry K, Bahnson TD, Ziegler PD. Relationship between atrial tachyarrhythmias and symptoms. Heart Rhythm. 2005;2(2):125-31. http://dx.doi.org/10.1016/j.hrthm.2004.10.042 PMid:15851283
Purerfellner H, Gillis AM, Holbrook R, Hettrick DA. Accuracy of atrial tachyarrhytmia detection in implantable devices with arrhythmia therapies. Pacing Clin Electrophysiol. 2004; 27:983-992. http://dx.doi.org/10.1111/j.1540-8159.2004.00569.x PMid:15271020
Boriani G, Glotzer TV, Santini M, et al. Device-detected atrial fibrillation and risk for stroke: an analysis of >10 000 patients from the SOS AF project (Stroke prevention strategies based on atrial fibrillation information from implanted devices). Eur Heart J. 2014; 35(8): 508-16 http://dx.doi.org/10.1093/eurheartj/eht491 PMid:24334432 PMCid:PMC3930873
Healey JS, Connolly SJ, Gold MR, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012; 366: 120â€“129. http://dx.doi.org/10.1056/NEJMoa1105575 PMid:22236222
Hohnloser SH, Capucci A, Fain E, et al. A Symptomatic atrial fibrillation and Stroke Evaluation in pacemaker patients and the atrial fibrillation Reduction atrial pacing Trial (ASSERT). Am Heart J. 2006; 152: 442-7. http://dx.doi.org/10.1016/j.ahj.2006.02.016 PMid:16923410
Freestone B, Lip GY. The endothelium and atrial fibrillation: the prothrombotic state revisited. Hamostaseologie. 2008; 28: 207â€“212. PMid:18836646
Guo Y, Lip GY, Apostolakis S. Inflammation in atrial fibrillation. J Am Coll Cardiol. 2012; 60: 2263â€“2270. http://dx.doi.org/10.1016/j.jacc.2012.04.063 PMid:23194937
Brambatti M, Connolly SJ, Gold MR et al. Temporal Relationship between Subclinical Atrial Fibrillation and Embolic Events. Circulation. 2014; 129: 2094-2099. http://dx.doi.org/10.1161/CIRCULATIONAHA.113.007825 PMid:24633881
Capucci A, Santini M, Padeletti L, et al. Monitored atrial fibrillation duration predicts arterial embolism events in patients suffering from bradycardia and atrial fibrillation implanted with antitachycardia pacemakers. J Am Coll Cardiol. 2005; 46:1913-1920. http://dx.doi.org/10.1016/j.jacc.2005.07.044 PMid:16286180
Martin DT, Bersohn MM, Waldo AL, et al. Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices. Eur Heart J. 2015; 36(26):1660-8. http://dx.doi.org/10.1093/eurheartj/ehv115 PMid:25908774
How to Cite
All rights reserved.