![]() ![]() 10 However, the prevalence and prognostic value of subclinical atrial fibrillation has been difficult to assess. 4,8,9 Subclinical atrial fibrillation is often suspected to be the cause of stroke in these patients. 3 About 15% of strokes are attributable to documented atrial fibrillation, and 50 to 60% to documented cerebrovascular disease, 4-7 but in about 25% of patients who have ischemic strokes, no etiologic factor is identified. 1,2 Epidemiologic studies indicate that many patients with atrial fibrillation on screening electrocardiograms had not previously received a diagnosis of atrial fibrillation. Jude Medical ASSERT number, NCT00256152.) IntroductionĪtrial fibrillation may be asymptomatic and consequently subclinical. Subclinical atrial tachyarrhythmias, without clinical atrial fibrillation, occurred frequently in patients with pacemakers and were associated with a significantly increased risk of ischemic stroke or systemic embolism. Continuous atrial overdrive pacing did not prevent atrial fibrillation. Subclinical atrial tachyarrhythmias remained predictive of the primary outcome after adjustment for predictors of stroke (hazard ratio, 2.50 95% CI, 1.28 to 4.89 P=0.008). The population attributable risk of stroke or systemic embolism associated with subclinical atrial tachyarrhythmias was 13%. Of 51 patients who had a primary outcome event, 11 had had subclinical atrial tachyarrhythmias detected by 3 months, and none had had clinical atrial fibrillation by 3 months. Subclinical atrial tachyarrhythmias were associated with an increased risk of clinical atrial fibrillation (hazard ratio, 5.56 95% confidence interval, 3.78 to 8.17 P<0.001) and of ischemic stroke or systemic embolism (hazard ratio, 2.49 95% CI, 1.28 to 4.85 P=0.007). Resultsīy 3 months, subclinical atrial tachyarrhythmias detected by implanted devices had occurred in 261 patients (10.1%). Patients with pacemakers were randomly assigned to receive or not to receive continuous atrial overdrive pacing. We monitored the patients for 3 months to detect subclinical atrial tachyarrhythmias (episodes of atrial rate >190 beats per minute for more than 6 minutes) and followed them for a mean of 2.5 years for the primary outcome of ischemic stroke or systemic embolism. We enrolled 2580 patients, 65 years of age or older, with hypertension and no history of atrial fibrillation, in whom a pacemaker or defibrillator had recently been implanted. We evaluated whether subclinical episodes of rapid atrial rate detected by implanted devices were associated with an increased risk of ischemic stroke in patients who did not have other evidence of atrial fibrillation. ![]() Pacemakers can detect subclinical episodes of rapid atrial rate, which correlate with electrocardiographically documented atrial fibrillation. One quarter of strokes are of unknown cause, and subclinical atrial fibrillation may be a common etiologic factor. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making. ![]()
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