Abstract 15998: Impact of Atrial Fibrillation Detected by Cardiac Implantable Electronic Devices on Embolic Stroke Events in Cancer Patients

Abstract

Background: Cancer patients have a higher risk of atrial fibrillation (AF) than general population, however, the link between cancer and AF is not fully understood. The association between AF detected by implanted cardiac implantable electronic devices (CIEDs) and the incidence of embolic stroke events has been reported. However, little is known about the incidence of AF and embolic stroke events in Japanese cancer patients with CIEDs. Moreover, the cut-off value of new-onset AF duration detected by CIEDs for embolic stroke is still unknown, and a problem to be solved in the future. The aim of this study is to identify the incidence of embolic stroke in Japanese cancer patients with a CIED and to examine the risk factors of embolic stroke. Methods: We retrospectively analyzed the database of our CIEDs clinic. Every 6 months, AF events were checked by CIEDs. Patients who had a history of AF or had received anticoagulant therapies before a CIED implantation and who are prescribed anticoagulants after a CIED implantation were excluded. We examined the characteristics and incidence of embolic stroke events and investigated the relationship between new-onset AF detected by CIEDs and the incidence of embolic stroke. Results: We enrolled 138 consecutive cancer patients with CIEDs who had no prior AF and took no anticoagulant in this study (follow-up period, 76±48 months; age, 73±16 years). During the follow-up period, 13 patients (9.4%) had embolic stroke events. Receiver-operating characteristic curve analysis confirmed that 20 seconds was the best cut-off value of AF duration detected by CIEDs for embolic stroke events (AUC = 0.75). Multivariate analysis demonstrated that independent predictors for embolic stroke were left atrial diameter ≥ 40mm (P=0.018) and new-onset AF ≥ 20 seconds (P = 0.0082). Conclusions: AF episodes lasting for ≥ 20 seconds and enlarged left atrium were the risk factors of embolic stroke events. We consider examining AF burden carefully in this population.