Purpose: Atrial fibrillation (AF) is a leading cause of
acute stroke, which is a significant cause of mortality
and long term disability in Europe. The risk of stroke can
be significantly reduced by the use of anticoagulation,
particularly now novel anticoagulants are available and
are simple to initiate. Permanent pacemakers can detect
asymptomatic episodes of rapid atrial rates (recognised on
interrogation as mode switching) which has been shown to
correlate with AF. Interrogation of pacemakers is therefore
a mechanism by which asymptomatic AF can be detected
for prevention of stroke.
Methods: We identified individuals who underwent a
permanent pacemaker insertion at our large district general
hospital between the dates of 01/01/2010 and 31/12/2014
(n=362), and excluded all individuals who had a diagnosis of
AF prior to implant (n=139). We collected data from pacing
follow up clinics of the remaining 223 individuals between
01/01/2010 and 01/05/2015. We looked at whether AF had
been detected, how it was detected and the demographics of
the individuals in which AF was identified.
Results: 36/223 of our population had at least one episode
of AF detected during the follow up period. Of these, two
were symptomatic from the AF and had presented acutely
to hospital. 27/36 had AF detected as a result of attendance
at routine follow up. 16/27 were detected by at least one
episode of mode switching of greater than 30 seconds
duration, and 11/27 were detected by being in AF at the
time of interrogation. The remaining 7/36 individuals had
mode switching episodes of less than 30 seconds duration.
The mean time from previous interrogation to diagnosis was
6 months, with 10/27 having 12 months between follow up.
The mean time from implant to diagnosis was 18 months.
26/27 individuals had a CHADS2VASC score of two or more
(mean 3). 1/27 had a stroke inbetween pacing checks before
AF was recognised and anticoagulation could be considered.
Conclusions: AF is an important risk factor for stroke
which can be detected by pacemaker interrogation and can
be used to improve prevention of stroke by anticoagulation.
Our study shows the potential in terms of stroke prevention
for increased monitoring of our pacemaker population for
AF. Remote telemonitoring has become increasingly used
in the follow up of devices and can allow for more frequent
interrogations to be performed at greater convenience
to the patient. We propose an increasing role for remote
monitoring to detect AF earlier which will have a significant
impact on the burden of stroke, both in terms of patient
outcome and health economics.