Impact of sinus node disease on atrial fibrillation prognosis: A community based cohort study - 05/01/18
Résumé |
Background |
Atrial fibrillation (AF) may commonly be associated with sinus node disease (SND) presenting as the so-called brady-tachy syndrome. Such patients are known to be at risk for embolic stroke. It remains unclear whether the risk of stroke is higher in this setting, and if antithrombotic management should be different, particularly in patients with a low CHA2DS2-VASc score.
Purpose |
We aimed to describe and compare the risk of stroke in AF patients with and with no SND.
Methods |
All patients with AF seen in our institution between 2000 and 2010 were identified in a database. Outcomes were investigated during follow-up.
Results |
Among 8962 patients with AF, 548 (6%) had SND among whom 237 (43%) where treated with a pacemaker. Patients with SND were older than patients with no SND (73.8±11.9 versus 70.6±14.7, P<0.0001), had higher CHA2DS2-VASc score (3.1±1.6 vs 2.9±1.7, P=0.02) and more frequent treatment with oral anticoagulation (OAC) (63% vs 57%, p=0.006). During a mean follow-up of 2.5 years, 715 stroke/thromboembolism (TE) and 1155 deaths were recorded. The rate of stroke/TE was similar in AF patients with SND versus other AF patients: HR=0.77, 95%CI 0.57–1.02, P=0.07 after adjustment for age, CHA2DS2-VASc score and OAC use. Findings were also similar in patients with low or high-risk for stroke according to the CHA2DS2-VASc score: adjusted HR 0.95 95%CI 0.46–1.99 in patients with 0 or 1 risk factor and adjusted HR 0.74 95% CI 0.54–1.01 in patients with ≥2 risk factors. In patients with SND, prescription of OAC was independently associated with a better prognosis for stroke/TE (HR=0.51, 95% CI 0.29–0.91, P=0.02 after adjustment on age and CHA2DS2-VASc score).
Conclusion |
AF patients with SND had a similar risk of stroke/TE than other AF patients. SND was not an independent risk factor for stroke when using a contemporary risk stratification scheme with the CHA2DS2-VASc score. Use of OAC was overall associated with a better prognosis in these patients.
Le texte complet de cet article est disponible en PDF.Plan
Vol 10 - N° 1
P. 85 - janvier 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?