Atrial fibrillation: Stroke:: was common in patients with permanent pacemakers

Clinical bottom line (level 2c)

  1. One in ten patients with a permanent pacemaker developed chronic atrial fibrillation within one year.
  2. One in four had a stroke within 2 years.
Mattioli et al: Clinical Cardiology 1998; 21: 117-122
Expires November 2003

The study

Outcome study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, Italy

210 patients (aged mean 79, 83% male) 100 with complete atrioventricular block or Mobitz type II block, and 110 with sick sinus syndrome (bradycardia-tachycardia syndrome, symptomatic inappropriate and persistent bradycardia, sinus arrest or cardioinhibitory carotid syndrome) who received a permanent pacemaker

Excluded if
  • clinically silent cerebral infarction found on CT
  • previous episodes of cerebral ischaemia and/or atrial fibrillation
  • congenital heart disease, dilated cardiomyopathy or valvular heart disease
  • treated with antiarrhythmic drugs




    • 100% followed for 2 years
    Outcomes studied:
  • chronic atrial fibrillation
  • cerebral ischaemia symptomatic stroke confirmed on CT
  • chronic atrial fibrillation
  • cerebral ischaemia

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    chronic atrial fibrillation 12 months 21/210 10%
    (5.9% to 14%)    		 10
    (7 to 17)
    cerebral ischaemia 12 months 32/210 15%
    (10% to 20%)    		 7
    (5 to 10)
    chronic atrial fibrillation 2 years 23/210 11%
    (6.7% to 15%)    		 7
    (5 to 10)
    cerebral ischaemia 2 years 53/210 25%
    (19% to 31%)    		 4
    (3 to 5)

    Citation

    1. Mattioli AV, Castellani ET, Vivoli D, et al: Prevalence of atrial fibrillation and stroke in paced patients without prior atrial fibrillation: a prospective study. Clinical Cardiology 1998; 21: 117-122
    Search Terms: ?
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer:

    Clinical Question.
    Patient permanent pacemaker
    Intervention or Exposure prevalence
    Outcome chronic AF, stroke