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Atrial fibrillation and stroke
Approximately a quarter of strokes are of unknown aetiology and, even given the rapid advances in acute treatment, prevention remains better than cure. This multi-centre study enrolled 2580 patients with no history of atrial fibrillation, in whom a pacemaker or defibrillator had recently been fitted. Subjects were randomly assigned to receive (or not) continuous atrial overdrive pacing. At 3 months, subclinical arrhythmias had occurred in 10% of patients. These were associated with an increased risk of embolic events (stroke or systemic embolism; HR 2.49). After 3 years, 51 patients had experienced embolic events, including 11 with a subclinical tachyarrhythmia, although none had clinical atrial fibrillation. Sadly, pacing did not alter the risk of an embolic event. It is debateable how representative is this group of patients, with cardiac problems severe enough to …
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