Stroke incidence in patients with cardiac implantable electronic devices remotely controlled with automatic alerts of atrial fibrillation. A sub-analysis of the HomeGuide Study

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 populat...

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Published in:International journal of cardiology 2016-09, Vol.219, p.251-256
Main 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
Format: Article
Language:English
Subjects:
Aged
Atrial fibrillation
Atrial Fibrillation - diagnosis
Atrial Fibrillation - epidemiology
Atrial Fibrillation - physiopathology
Cardiac Resynchronization Therapy Devices - trends
Cardiovascular
Defibrillators, Implantable - trends
Electrocardiography, Ambulatory - methods
Electrocardiography, Ambulatory - trends
Female
Follow-Up Studies
Humans
Implantable cardioverter defibrillators
Incidence
Male
Middle Aged
Pacemaker, Artificial - trends
Pacemakers
Remote monitoring
Stroke
Stroke - diagnosis
Stroke - epidemiology
Stroke - physiopathology
Telemedicine
Telemedicine - methods
Telemedicine - trends
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Summary: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 four years, the incidence of thromboembolic events was less than half the estimations based on the CHA2 DS2 VASc risk profile.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2016.06.016