Type the Characteristics of Pacemaker (PM) Patients Admitted in Stroke Unit: The Stroke Pacemaker Study (SPACES)
M. Spinelli
Stroke Unit, IRCCS C. Mondino, Pavia and IRCCS San Raffaele, Milano, Italy
G. Silvestrelli
Stroke Unit, Division of Neurology, C. Poma Hospital, Mantova, Italy
S. Micheli
Neurofisiologia, Spoleto, Italy
M. Paciaroni
Stroke Unit, University of Perugia, Italy
G. Agnelli
Stroke Unit, University of Perugia, Italy
A. Lanari
Stroke Unit, Division of Neurology, C. Poma Hospital, Mantova, Italy
F. Corea *
Brain Injury Unit, San Giovanni Battista, Foligno, Italy
*Author to whom correspondence should be addressed.
Abstract
Aims: According to recent surveys, despite health care authority’s budget reductions, the total amount of PM implants increased worldwide. Even if the diffusion of these devices is large no data are available concerning the characteristics of PM patients hospitalized for stroke.
Study Design: The SPACES study is a retrospective observational study conducted in 3 hospital centres including paced patients consecutively admitted for acute stroke. The objective is to determine the characteristics of patients with PM admitted in the stroke units.
Place and Duration of Study: In 3 Italian general hospital (Perugia, Milano, Mantova), from January 2005 to September 2008.
Method: At admission all patients underwent non-contrast computed tomography (CT), routine biological tests, 12-lead ECG. The ECG was categorized in following subgroups: a) sinus rhythm; b) AF rhythm; c) PM-induced activity (when was not possible to state the underlying rhythm).
Results: In the study population were recorded 73 ischemic strokes, 10 hemorrhagic events and 19 TIA. At the basal ECG a “pacemaker-induced” rhythm was diagnosed in 37 cases, sinus rhythm in 28, AF in 32 subjects. At the univariate analysis patients with an ECG-detected AF rhythm at admission were more often those with positive AF medical history (p<.001) and treated with aspirin prior to the index event (p=.023). Patients with an ECG-detected AF at admission more often suffered a Total Anterior Cerebral Infarction (TACI) subtype of stroke (p=.038) having cardioembolism as cause (p<.001).
Conclusions: Our survey suggests that paced patients suffer more often, than unselected case-series, of ischemic strokes due to cardioembolic events. Moreover AF is the leading risk factor in PM subjects. Probably PM-induced electric activity may further confound the detection of the baseline ECG, with an underestimation of AF.
Keywords: Stroke, pacemaker, atrial fibrillation