Temporal Relationship of Atrial Tachyarrhythmias, Cerebrovascular Events, and Systemic Emboli Based on Stored Device Data: a Subgroup Analysis of TRENDS

Background: The temporal relationship between atrial tachyarrhythmias (atrial tachycardia [AT] and atrial fibrillation [AF]) and cerebrovascular events/systemic emboli (CVE/SE) is unknown.

Objective: The purpose of this study was to evaluate this relationship using stored AT/AF diagnostic data from implanted devices in patients with and those without AF.

Methods: The TRENDS study enrolled 2,486 patients with an indication for an implantable device, at least one stroke risk factor, and available device data. The current study includes the subgroup of 40 (1.6%) patients enrolled in TRENDS who experienced CVE/SE.

Results: AT/AF was detected prior to CVE/SE in 20 (50%) of 40 patients. Other than average and maximum daily AT/AF burden and duration of device monitoring prior to CVE/SE, no statistically significant differences were found between patients with and those without AT/AF prior to CVE/SE. For the 20 patients with AT/AF detected prior to CVE/SE, 9 (45%) did not have any AT/AF in the 30 days prior to CVE/SE. Therefore, 29 (73%) of 40 patients with CVE/SE had zero AT/AF burden within 30 days prior to CVE/SE. Fourteen (70%) of the 20 patients with AT/AF detected prior to CVE/SE were not in AT/AF at diagnosis of CVE/SE. The last episode of AT/AF in these 14 patients was 168 ± 199 days (range 3-642 days) before CVE/SE.

Conclusion: The majority of CVE/SE in this population did not occur proximal to recent AT/AF episodes. These data imply that the mechanisms of CVE/SE in patients with implantable devices may importantly involve mechanisms other than cardioembolism due to atrial tachyarrhythmias.