Stroke incidence in patients with cardiac implantable electronic devices remotely controlled with automatic alerts of atrial fibrillation. A sub-analysis of the HomeGuide study. (15th September 2016)

• Record Type: Journal Article
• Authors: Ricci, Renato Pietro; Vaccari, Diego; Morichelli, Loredana; Zanotto, Gabriele; Calò, Leonardo; D'Onofrio, Antonio; Curnis, Antonio; Pisanò, Ennio C.L.; Nangah, René; Brieda, Marco; Calzolari, Vittorio; Melissano, Donato; Rovai, Nicola; Gargaro, Alessio
• Is Part Of: International journal of cardiology. Volume 219(2016)
• Page Start: 251
• Page End: 256
• Publication Date: 2016-09-15
• Subjects: Pacemakers -- Implantable cardioverter defibrillators -- Remote monitoring -- Telemedicine -- Atrial fibrillation -- Stroke; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.06.016
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract : Background : Remote Monitoring (RM) of cardiac implantable electronic devices (CIEDs) is recommended in management of Atrial Fibrillation (AF), which is a recognized risk factor for thromboembolism. We tried to elucidate whether stroke incidence observed in a large, remotely monitored population was consistent with the CHA2 DS2 VASc risk profile. Methods : Data from 1650 patients [76% male, age 72 (63–68), CHA2 DS2 VASc score 3.0 (2.0–4.0)] enrolled during the HomeGuide study and monitored with a daily-transmission RM system providing automatic alerts for AF, were analysed. Of those, 25% had a pacemaker and 75% an implantable cardioverter defibrillator with or without cardiac resynchronization. Estimations of the expected thromboembolic events were based on the population CHA2 DS2 VASc score profile used in a computer-simulated Markov model. Results : Eight thromboembolic events were observed with a 4-year cumulative stroke rate of 0.8% (confidence interval, 0.4%–1.5%). Simulations returned from 18.7 to 17.1 expected events, depending on the AF duration assumed to trigger anticoagulation (one-sample log-rank p < 0.03). During the study period, 681 (84%) AF episodes and 129 (16%) atrial tachycardias were detected in 291 patients (18%): 93% of episodes were detected remotely in 269 patients, 66% of whom had no history of AF. Medical interventions were necessary in 305 episodes, 85% of which were detected remotely. Reaction time was 1 (0–6) days for remotely-detected episodes and 33 (14–121) days for episodes detected in clinic (p < 0.0001). Conclusions : In a large CIED population followed remotely for up to 4 years, the incidence of thromboembolic events was less than half the estimations based on the CHA2 DS2 VASc risk profile.