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)
Open accessAbstract
OBJECTIVE: The aim of this study was to assess the association between maximum daily atrial fibrillation (AF) burden and risk of ischaemic stroke. BACKGROUND: Cardiac implanted electronic devices (CIEDs) enhance detection of AF, providing a comprehensive measure of AF burden. DESIGN, SETTING, AND PATIENTS: A pooled analysis of individual patient data from five prospective studies was performed. Patients without permanent AF, previously implanted with CIEDs, were included if they had at least 3 months of follow-up. A total of 10 016 patients (median age 70 years) met these criteria. The risk of ischaemic stroke associated with pre-specified cut-off points of AF burden (5 min, 1, 6, 12, and 23 h, respectively) was assessed. RESULTS: During a median follow-up of 24 months, 43% of 10 016 patients experienced at least 1 day with at least 5 min of AF burden and for them the median time to the maximum AF burden was 6 months (inter-quartile range: 1.3-14). A Cox regression analysis adjusted for the CHADS2 score and anticoagulants at baseline demonstrated that AF burden was an independent predictor of ischaemic stroke. Among the thresholds of AF burden that we evaluated, 1 h was associated with the highest hazard ratio (HR) for ischaemic stroke, i.e. 2.11 (95% CI: 1.22-3.64, P = 0.008). CONCLUSIONS: Device-detected AF burden is associated with an increased risk of ischaemic stroke in a relatively unselected population of CIEDs patients. This finding may add to the basis for timely and clinically appropriate decision-making on anticoagulation treatment.
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Strokes often occur without AHRE detected within 30 days before the event.
“Strokes often occur without AHRE detected within 30 days before the event.143-147”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [144]
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- Authors
- Boriani, G., Glotzer, T. V., Santini, M., West, T. M., De Melis, M., Sepsi, M., Gasparini, M., Lewalter, T., Camm, J. A., & Singer, D. E.
- Affiliations
- IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
- Hackensack University Medical Center (US)
- Ospedale San Filippo Neri (IT)
- Medtronic (Netherlands) (NL)
- IRCCS Humanitas Research Hospital (IT)
- TUM Klinikum (DE)
- Harvard University (US)
- Corresponding author
- Boriani, Giuseppe
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-12-11
- Volume
- 35
- Issue
- 8
- Pages
- 508-516
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC3930873
- OpenAlex
- W2145610874
- Cited by
- 427
- References
- 24
- Citations by year
- 2026: 25 · 2025: 19 · 2024: 42 · 2023: 18 · 2022: 28 · 2021: 37 · 2020: 42 · 2019: 35 · 2018: 52 · 2017: 48 · 2016: 38 · 2015: 31 · 2014: 12
- FWCI
- 18.16
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- European Heart Journal (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- atrial fibrillation, device-detected atrial fibrillation, ischemic stroke risk, atrial fibrillation burden, cardiac implantable electronic devices, anticoagulation, CHADS2 score, stroke prevention
- MeSH terms
- Aged, Anticoagulants, Atrial Fibrillation, Ischemic Attack, Transient, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Defibrillators, Implantable, Cost of Illness, Stroke, Kaplan-Meier Estimate, Observational Studies as Topic
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