Silent brain infarcts in high blood pressure patients with cardiac implantable electronic devices: unmasking silent atrial fibrillation.

BACKGROUND: Hypertensive patients present a higher risk for developing atrial fibrillation and its complications. Cardiac implantable electronic devices (CIEDs) have shown reliable atrial fibrillation detection as atrial high-rate episodes (AHREs). The presence of AHRE more than 5 min has been related to increased risk of stroke, but a high proportion of ischemic brain lesions (IBLs) could be subclinical and thromboembolic risk underestimated.

METHODS: We included hypertensive patients with CIED and we analyzed the incidence of AHRE and the presence of IBL on computed tomography (CT) scan.

RESULTS: One hundred and twenty-three patients (57% men) aged 77 ± 8 years were evaluated during a mean follow-up of 15 ± 9 months. AHREs were documented in 46 patients (37%). Cranial CT scan showed silent IBL in 34 patients (27%). Univariate analysis showed that age, CHADS2 and CHADS2VA2Sc scores, history of prior stroke/ transient ischemic attack and the presence of AHRE were significantly related to higher risk for IBL on CT scan (P < 0.05). Multivariate analysis showed that the presence of AHRE more than 5 min [odds ratio 3.05 (1.19-7.81; P < 0.05)] was an independent predictor of IBL.

CONCLUSION: Silent atrial fibrillation detected by CIED as AHRE is really prevalent in hypertensive patients. AHREs were independently associated with a higher incidence of silent IBL on CT scan.