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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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Stroke and Atrial Fibrillation
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Prolonged Cardiac Monitoring for Atrial Fibrillation Detection After Stroke
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Understanding atrial failure: from diagnosis to clinical implications
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Etiology of Cryptogenic Stroke
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“24 Therefore, it is hypothesized that (subclinical) AF is rather a risk factor for stroke than a direct cause.”
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“41 42 Similarly, AF burden is a dynamic entity and can progress, remain stable or regress over time.”
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“This evidence strongly implies that AF may be an intermittent marker of a more persistent, underlying pathology rather than the direct and singular cause of every thrombus [8].”
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“Moreover, studies have shown that AHREs have different predictors when compared to AF, and are not temporally associated with the risk of stroke [4,5].”
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“Thrombotic and embolic foci can form because of atrial cardiopathy, even in the absence of atrial fi brillation (AF) [6 – 8].”
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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