• Matthew Pugh, Peter Belott, Kristina L Greenwood, Patricia L McNamee, Besa Smith, Terri L Craig, Jack Mardekian, Jeffrey Trocio, Divina Fanning, and Eric Carda.
• Sharp HealthCare, San Diego, California.
• J Emerg Med. 2019 Oct 1; 57 (4): 437-443.

BackgroundClinical guidelines emphasize identifying atrial fibrillation (AF) as a strategy to reduce stroke risk. Cardiac implantable electronic device (CIED) interrogation at the point of care may facilitate AF detection, increasing opportunities to identify patients at high risk for stroke.ObjectivesThis study sought to quantify AF prevalence and assess stroke risk in patients with a CIED who presented to the emergency department (ED).MethodsThis noninterventional, retrospective observational study included adult patients who presented at a single facility ED that incorporated device interrogation as a routine standard practice for all patients with a CIED. Interrogations were conducted in 494 unique patients, and relevant demographic/clinical information was captured from electronic medical records.ResultsAF was detected via CIED interrogation in 54.8% (271/494) of the unique patient population that presented to the ED. Device interrogation detected the presence of AF in 110 patients without a documented past history or current diagnosis of AF, representing 22.3% (110/494) of total unique patients. Based on CHA2DS2-VASc (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65-74 years, Sex category [female]) risk scoring methodology, over three-quarters of these newly detected AF patients (78.2%, 86/110) were classified in a high stroke risk category that reflected a > 2.2% annualized risk, and over half (57.3%, 63/110) presented to the ED for reasons unrelated to cardiac/dysrhythmia problems.ConclusionsThe use of technology-assisted device interrogation of CIEDs at the point of care has promise in identifying patients with asymptomatic AF. Results suggest consideration of routine device interrogation of CIEDs in the ED, regardless of reason for admission or history of AF.Copyright © 2019 Elsevier Inc. All rights reserved.

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