The Relationship Between Daily Atrial Tachyarrhythmia Burden From Implantable Device Diagnostics and Stroke Risk

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Abstract
Background— It is unknown if brief episodes of device-detected atrial fibrillation (AF) increase thromboembolic event (TE) risk. Methods and Results— TRENDS was a prospective, observational study enrolling patients with ≥1 stroke risk factor (heart failure, hypertension, age ≥65 years, diabetes, or prior TE) receiving pacemakers or defibrillators that monitor atrial tachycardia (AT)/AF burden (defined as the longest total AT/AF duration on any given day during the prior 30-day period). This time-varying exposure was updated daily during follow-up and related to TE risk. Annualized TE rates were determined according to AT/AF burden subsets: zero, low (P =0.97) and 2.20 (0.96 to 5.05, P =0.06), respectively. Conclusions— The TE rate was low compared with patients with traditional AF with similar risk profiles. The data suggest that TE risk is a quantitative function of AT/AF burden. AT/AF burden ≥5.5 hours on any of 30 prior days appeared to double TE risk. Additional studies are needed to more precisely investigate the relationship between stroke risk and AT/AF burden.