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Temporal Relationship Between Subclinical Atrial Fibrillation and Embolic Events
Open accessAbstract
BACKGROUND: Among patients with implantable pacemakers and defibrillators, subclinical atrial fibrillation (SCAF) is associated with an increased risk of stroke; however, there is limited understanding of their temporal relationship. METHODS AND RESULTS: The Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT) enrolled 2580 pacemaker and defibrillator patients aged ≥65 years with a history of hypertension but without a history of atrial fibrillation. Pacemakers and implantable cardioverter-defibrillators precisely logged the time and duration of all episodes of SCAF and recorded electrograms that were adjudicated by experts. We examined the temporal relationship between SCAF >6 minutes in duration and stroke or systemic embolism. Of 51 patients who experienced stroke or systemic embolism during follow-up, 26 (51%) had SCAF. In 18 patients (35%), SCAF was detected before stroke or systemic embolism. However, only 4 patients (8%) had SCAF detected within 30 days before stroke or systemic embolism, and only 1 of these 4 patients was experiencing SCAF at the time of the stroke. In the 14 patients with SCAF detected >30 days before stroke or systemic embolism, the most recent episode occurred at a median interval of 339 days (25th to 75th percentile, 211-619) earlier. Eight patients (16%) had SCAF detected only after their stroke, despite continuous monitoring for a median duration of 228 days (25th to 75th percentile, 202-719) before their event. CONCLUSIONS: Although SCAF is associated with an increased risk of stroke and embolism, very few patients had SCAF in the month before their event. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00256152.
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“The detection of supraventricular tachycardia (SVT) may be important as well as it is associated with the development of AF and an increased risk of stroke even in patients without AF (4–6).”
From Diagnostic Yield of Extended Cardiac Patch Monitoring in Patients with Stroke or TIA (2015) · cites this paper as [5]
Experimental — accuracy not yet measuredIn the citing paper
“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 [143]
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“Nevertheless, studies conducted in patients with implanted devices and who suffered a thromboembolic event showed that, in a large portion of patients, no AF events occurred the months before [30,31].”
BackgroundSilent atrial fibrillation: Definition, clarification, and unanswered issues
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Atrial Cardiopathy and Cryptogenic Stroke
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“Prevention of AF is also import‐ ant as treatment of AF because 35% of ischemic strokes due to AF occurs at first AF attack of a particular patient (Brambatti et al., 2014).”
BackgroundState of the art of mobile health technologies use in clinical arrhythmia care
Sridhar, A. R. M., Cheung, J. W., Lampert, R., Silva, J. N. A., Gopinathannair, R., Sotomonte, J. C., Tarakji, K. G., Fellman, M., Chrispin, J., Varma, N., et al. (2024) · Communications Medicine · doi:10.1038/s43856-024-00618-4 · Cited by 30
“However, othershaveshownthatischemic stroke was temporally discordant from AF episodes such that most patients withischemicstrokedidnothaveAFintheprecedingdaysorweeks 45 .”
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Relationship between left atrial volume and ischemic stroke subtype
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“Moreover, the majority of ischemic strokes do not occur proximal to recent episodes of atrial tachycardia or AF, as shown in patients with implantable cardiac monitoring devices in the ASSERT (Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Paci…”
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“As a high percentage of patients were not in AF prior to their thromboembolic event, it is likely that there are other mechanisms involved besides stasis in the generation of thromboembolism in AF [36, 37].”
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Subclinical Atrial Fibrillation and Risk of Stroke: Past, Present and Future
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“Brambatti and colleagues performed a subanalysis of the ASSERT trial to assess the temporal association between SCAF and stroke and systemic embolism; the analysis included SCAF >6 minutes [38].”
BackgroundMethodInfluentialThe Complex Relation between Atrial Cardiomyopathy and Thrombogenesis
D’Alessandro, E., Winters, J., van Nieuwenhoven, F. A., Schotten, U., & Verheule, S. (2022) · Cells · doi:10.3390/cells11192963 · Cited by 27
“Finally, multiple pleiotropic effects of coagulation factors have been identified in various tissues over the past 10 years, including prohypertrophic, proinflammatory and profibrotic effe ts [111].”
BackgroundInfluentialAtrial Fibrillation and Diabetes Mellitus: Dangerous Liaisons or Innocent Bystanders?
Lorenzo-Almorós, A., Casado, J., Walther, L. A. Á.-S., Méndez‐Bailón, M., & Lorenzo, Ó. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12082868 · Cited by 27
“Indeed, AF can be considered a cardiac biomarker of advanced atrial myopathy closely related to ventricular myopathy and specifically, heart failure with preserved ejection fraction (HFpEF) [6].”
Background
Metadata
- Authors
- Brambatti, M., Connolly, S. J., Gold, M. R., Morillo, C. A., Capucci, A., Muto, C., Lau, C. P., Van Gelder, I. C., Hohnloser, S. H., Carlson, M., Fain, E., Nakamya, J., Mairesse, G. H., Halytska, M., Deng, W. Q., Israel, C. W., & Healey, J. S.
- Affiliations
- Goethe University Frankfurt (DE)
- From the Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (M.B., S.J.C., C.A.M., J.N., M.H., W.Q.D., J.S.H.); Clinica di Cardiologia, Università Politecnica delle Marche, Ancona, Italy (M.B., A.C.); Medical University of South Carolina, Charleston (M.R.G.); Cardiology Department, Loreto Mare, Napoli, Italy (C.M.); Queen Mary Hospital, Department of Medicine, University of Hong Kong, Hong Kong, China (C.P.L.); University of Groningen, University Medical Center...
- ORCID
- Venue
- Circulation
- Published
- 2014-05-27
- Volume
- 129
- Issue
- 21
- Pages
- 2094-2099
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2024497977
- Cited by
- 676
- References
- 31
- Citations by year
- 2026: 21 · 2025: 35 · 2024: 52 · 2023: 66 · 2022: 62 · 2021: 67 · 2020: 55 · 2019: 63 · 2018: 57 · 2017: 66 · 2016: 58 · 2015: 57 · 2014: 15
- FWCI
- 44.81
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- 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 › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- subclinical atrial fibrillation, stroke, systemic embolism, implantable cardioverter-defibrillator, cardiac pacemaker, temporal relations, asymptomatic atrial fibrillation, hypertension
- MeSH terms
- Aged, Aged, 80 and over, Atrial Fibrillation, Embolism, Female, Follow-Up Studies, Humans, Male, Pacemaker, Artificial, Prospective Studies, Risk Factors, Time Factors, Stroke
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