DIAGNOSTICS OF ATRIAL FIBRILLATION IN PATIENTS WITH IMPLANTABLE CARDIAC ELECTRONIC DEVICES: PREVALENCE AND RISK FACTORS

Aim. To evaluate the prevalence and to search for the risk factors of atrial fibrillation (AF) development in patients with implantable cardiac electronic devices (dualchamber stimulators (ECS), implantable cardioverter-defibrillators and resynchronizers).

Material and methods. The design of the study is prospective single center, with consequent inclusion of 304 patients at the age ≥18 y.o. and with no documented AF in anamnesis, with indications for implantation of replacement of ECS. Patients followup lasted for 12-18 months with 1-3 months periodicity visits. In the analysis of data on rhythm disorders, stored in ECS memory, as significant the episodes of high cardiac rate with duration more 6 minutes per day and detection rate more than 175- 180 beats per minute were taken. Also, in all the patients clinical and demographic data was assessed, laboratory and echocardiography methods applied.

Results. The study was completed in 224 patients, the rest were lost at different stages. AF was found in 57 (25,4%), and in 43 (75,4%) the episode were nonsymptomatic. In 3 months after implantation, AF revealing rate was 14,9% (38 patients of 255 at the 1st visit). Independent risk factors for AF were thromboembolic complications in anamnesis (HR 4,72; 95% CI 2,279-9,77; р<0,0001), increased left atrium volume index (HR 2,07; 95% CI 1,075-3,975; р=0,029), and hemoglobin level decrease (HR 2,58; 95% CI 1,245-5,35; р=0,011).

Conclusion. The prevalence of AF in the patients with implantable cardiac devices is quite high. Most patients have their episodes asymptomatic. Most commonly, AF is found during 3 months from the operation. Risk factors for AF according to our data, were thromboembolic complications in anamnesis, increased left atrium volume index, and hemoglobin level decrease.

1. Chugh S, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 2014; 129: 837-47.

2. Kishore A, Vail A, Majid A, et al. Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Stroke 2014; 45: 520-6.

3. Kennedy HL. Silent Atrial Fibrillation: Definition, Clarification, and Unanswered Issues. Ann Noninvasive Electrocardiol. 2015 Nov; 20 (6): 518-25.

4. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Russian Journal of Cardiology. 2017; 7: 7-86. DOI: 10.15829/1560-4071-2017-7-7-86 (In Russ.) Рекомендации ESC по лечению пациентов с фибрилляцией предсердий, разработанные совместно с EACTS. Российский кардиологический журнал. 2017; 7: 7-86.

5. Healey J, Connolly S, Gold M, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012; 366 (2): 120-9.

6. Glotzer T, Daoud E, Wyse D, et.al. The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk: the TRENDS study. Circ Arrhythm Electrophysiol. 2009; 2 (5): 474-80.

7. Mittal S, Stein K, Gilliam FR 3rd, et al. Frequency, duration, and predictors of newlydiagnosed atrial fibrillation following dual-chamber pacemaker implantation in patients without a previous history of atrial fibrillation. Am J Cardiol. 2008; 102 (4): 450-3.

8. Orlov MV, Ghali JK, Araghi-Niknam M, et al. Asymptomatic atrial fibrillation in pacemaker recipients: incidence, progression, and determinants based on the atrial high rate trial. Pacing Clin Electrophysiol. 2007; 30 (3): 404-11.

9. Kamel H, Okin PM, Elkind MS, et al. Atrial Fibrillation and Mechanisms of Stroke: Time for a New Model. Stroke. 2016; 47 (3): 895-900.

10. Brambatti M, Connolly SJ, Gold MR, et al.Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation. 2014; 129 (21): 2094-9.

11. Ythan H. Goldberg. Relationship Between Atrial Fibrillation and Left Atrial Size. Jacc. 2007.11.030