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Pacemaker interrogation to detect asymptomatic AF may improve stroke prevention
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Pacemaker interrogation can aid in stroke prevention by allowing for earlier initiation of anticoagulant therapy upon identification of subclinical atrial fibrillation, according to data presented at Acute Cardiovascular Care 2015.
The study included 223 patients who received a pacemaker between 2010 and 2014 and did not have a prior diagnosis of AF. The researchers evaluated whether and how AF was detected in these patients, and calculated stroke risk using the CHA2DS2-VASc score.
“The proportion of pacemaker patients with undiagnosed AF was higher than expected,” researcher Nathan Denham, MD, a cardiologist at Warrington Hospital, United Kingdom, said in a press release. “Nearly all of them should have been receiving anticoagulation to prevent stroke. Pacemaker checks are simple to perform and our study shows that it is worthwhile using them to identify patients at risk.”
The researchers observed 36 episodes of AF, including 27 episodes identified through a routine pacemaker interrogation that resulted in new AF diagnoses. The mean time from the previous pacemaker interrogation to diagnosis was 6 months, including 10 patients not diagnosed for 12 months.
Twenty-six of 27 patients had a CHA2DS2-VASc score of at least 2, indicating a recommendation for oral anticoagulation to prevent stroke according to European Society of Cardiology guidelines.
Based on these results, the researchers said that remote telemonitoring would be useful to prevent stroke in patients with subclinical AF by allowing for more frequent pacemaker interrogations.
“Stable patients have pacemaker checks every 12 months, but our results support more frequent monitoring to identify AF,” Denham said in the release. “Otherwise patients are at increased stroke risk and are left unprotected … Telemonitoring would identify AF much earlier so that anticoagulation could be started. The fact that we found such a high proportion of patients with AF who should have been on anticoagulation suggests that telemonitoring is worth pursuing.” – by Will Offit
Reference:
Denham N, et al. Abstract P181. Presented at: Acute Cardiovascular Care; Oct. 17-19, 2015; Vienna.
Disclosure: The researchers report no relevant financial disclosures.