Abstract 17542: Impact of New-Onset Atrial Fibrillation Detected by Cardiac Implantable Electronic Devices on Embolic Stroke Events

Abstract

Background: The association between atrial fibrillation (AF) detected by implanted cardiac implantable electronic devices (CIEDs) and the incidence of embolic stroke has been reported. However, the cut-off value of new-onset AF duration detected by CIEDs for embolic stroke is still unknown. In previous studies regarding the cut-off value of AF duration, patients who had a history of AF or had received anticoagulant therapies were also included. Therefore, the solo effect of AF on the risk of embolic stroke cannot be reliably evaluated on these studies. The aim of this study is to identify the incidence of embolic stroke in Japanese patients with a CIED and examine the cut-off value of AF duration detected by CIEDs as a risk factor for 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 and after a CIED implantation were excluded. We examined the characteristics and incidence of embolic stroke and investigated the relationship between new-onset AF detected by CIEDs and the incidence of embolic stroke. Results: We enrolled 710 consecutive patients who were followed-up at our CIED clinic. We excluded 360 patients who had a history of AF or had received anticoagulant therapies. Finally, 350 patients (follow-up period, 75±58 months; age, 70±16 years) were included in this study. During the follow-up period, 24 patients (6.9%) had embolic stroke. Receiver-operating characteristic curve analysis confirmed that 30 seconds was the best cut-off value of AF duration detected by CIEDs for embolic stroke (AUC = 0.72). Multivariate analysis demonstrated that independent predictors for embolic stroke were left atrial diameter ≥40mm (p=0.019), new-onset AF ≥ 30 seconds (p = 0.0016). Conclusion: AF episodes lasting for ≥ 30 seconds was the risk factor of embolic stroke. We should evaluate AF burden carefully in this population.