• Marco Proietti, Giulio Francesco Romiti, Marco Vitolo, Marco Borgi, RoccoArianna DiADDepartment of Public Health and Infectious Diseases, Sapienza-University of Rome, Rome, Italy., Alessio Farcomeni, Kazuo Miyazawa, Jeff S Healey, Deirdre A Lane, Giuseppe Boriani, Stefania Basili, and LipGregory Y HGYHLiverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address:.
• Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
• Eur. J. Intern. Med. 2022 Sep 1; 103: 84-94.

BackgroundIn recent years, attention to subclinical atrial fibrillation (SCAF), defined as the presence of atrial high-rate episodes (AHREs), in patients with cardiac implantable electronic devices (CIEDs), has gained much interest as a determinant of clinical AF and stroke risk. We aim to perform a systematic review and meta-regression of the available scientific evidence regarding the epidemiology of SCAF in patients receiving CIEDs.MethodsPubMed and EMBASE were searched for all studies documenting the prevalence of AHREs in patients (n=100 or more, <50% with history of AF) with CIEDs from inception to 20th August 2021, screened by two independent blind reviewers. This study was registered in PROSPERO: CRD42019106994.ResultsAmong the 2614 results initially retrieved, 54 studies were included, with a total of 72,784 patients. Meta-analysis of included studies showed a pooled prevalence of SCAF of 28.1% (95%CI: 24.3-32.1%), with high heterogeneity between studies (I2=98%). A multivariable meta-regression was able to explain significant proportion of heterogeneity (R2=61.9%, p<0.001), with age and follow-up time non-linearly, directly and independently associated with occurrence of SCAF. Older age, higher CHA2DS2-VASc score, history of AF, hypertension, CHF, and stroke/TIA were all associated with SCAF occurrence.ConclusionsIn this systematic review and meta-regression analysis, SCAF was frequent among CIED recipients and was non-linearly associated with age and follow-up time. Older age, higher thromboembolic risk, and several cardiovascular comorbidities were associated with presence of SCAF.Copyright © 2022. Published by Elsevier B.V.

11 keywords...

hide…