FREQUENCY OF ASYMPTOMATIC ATRIAL FIBRILLATION AND RISK OF STROKE IN PATIENTS WITH PACEMAKER DEVICE IMPLANTATION

Abstract

Objective: To find out the frequency of asymptomatic atrial fibrillation with cardiac implantable electronic device (CIED) and to stratify them for developing thromboembolic complications by using CHA2DS2-VASc scoring system.

Study Design: Cross-sectional study

Place and Duration of Study: Cardiac Electrophysiology department of Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC/NIHD) Rawalpindi, from January to June 2018.

Methods: Study participants included all consecutive patients, fulfilling the inclusion criteria, reporting to our department with complete AV block and were hospitalized and implanted with dual chamber permanent pacemaker device via subclavian approach. Complete medical history and physical examination were obtained for all patients prior to device implantation and upon 6 months follow-up, presence of any pacemaker-detected AF was documented along with duration of longest AF episode.

Results: Sixty three patients were implanted with a PPM cardiac device and AF was detected in 43 out of 63 patients (68.2%), where 41 (65.0%) cases of AF were with more than 5 minutes duration, while 2 (3.2%) with less than 5 minutes duration. Significant associations have also been found among development of device detected AF with hypertension, previous history of AF and CHA2DS2VASc score of >2 with a p value of 0.001, 0.039 and 0.04 respectively.

Conclusion: High incidence of asymptomatic atrial fibrillation mandates careful follow-up of patients with implanted cardiac deviceand patients with high risk of developing cerebrovascular thromboembolic events should be considered for oral anticoagulation therapy.