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Cardiovascular Disease |

Risk Factors Associated to Stroke in Patients With Pacemakers and Implantable Cardioverter Defibrillator at an Outpatient Clinic in the City of Salvador, Bahia, Brazil

Elieusa Sampaio, MD; Roque Aras Júnior, PhD; José Alberto da Matta, PhD; Cristiano Macedo, MD; Márcia Maria Oliveira, RN; Ubiratan dos Santos Júnior, MS; Sérgio Câmara, MS
Author and Funding Information

Federal University of Bahia, Salvador, Brazil


Chest. 2014;145(3_MeetingAbstracts):83A. doi:10.1378/chest.1834748
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Abstract

SESSION TITLE: Cardiovascular Disease Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: The risk of stroke associated to the various means of cardiac stimulation is still limited and offers only tendencies. It is only known that patients with sinus node dysfunction are in risk of stroke and suggest that ventricular demand pacemakers do not offer protection against this risk.

METHODS: A cross-sectional analysis was made of the medical records of 74 patients with pacemakers or implantable cardioverter defibrillator (ICD) attended at a cardiology outpatient clinic of a University hospital in the city of Salvador, between September/2003 and June/2008. Socio-demographic, clinical and anticoagulant therapy information was obtained from the medical records of the patients.

RESULTS: The average age was of 60 years, 89,2% with pacemakers and 10,8% with ICD, 51,4% of the male sex, 8,1% were diabetics, 45,9% were mulatto, 52,7% presented a left ventricular ejection fraction lower than 45%, 10,8% suffered Coronary Artery Disease (CAD), 5,4% with chronic renal failure, 2,7% had a history of Pulmonary Thromboembolism, 70,3% of the patients presented chagasic cardiopathy, 93,2% did not use anticoagulants and 58,1% did not use platelet antiaggregant. With reference to the cardiac rhythm, 9,5% presented an atrial fibrillation rhythm on the electrocardiogram performed in the outpatient clinic. There were 21 cases of stroke significantly more frequent in the group of patients with CAD (odds ratio[OR] : 0.19, p= 0.024) , in diabetics ([OR]: 0.16 , p=0.030) and those with chronic renal failure ([OR]: 0.120, p=0.039). In relation to chagasic and non-chagasic patients, the use of pacemakers or ICD, atrial fibrillation, gender, race, use of anticoagulants or platelet antiaggregants, left ventricular ejection fraction lower than 45% and pulmonary thromboembolism did not evidence association with stroke.

CONCLUSIONS: Our study demonstrated a higher frequency of stroke in patients with pacemakers presenting CAD, diabetes and chronic renal failure.

CLINICAL IMPLICATIONS: Strategies for the strict monitoring and control of the cardiac rhythm is necessary to evaluate possible thrombotic complications in patients using pacemakers, as well as an early initiation of anticoagulant therapy.

DISCLOSURE: The following authors have nothing to disclose: Elieusa Sampaio, Roque Aras Júnior, José Alberto da Matta, Cristiano Macedo, Márcia Maria Oliveira, Ubiratan dos Santos Júnior, Sérgio Câmara

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