Brief Episodes of Silent Atrial Fibrillation Were Associated With an Increased Risk of Silent Cerebral Infarct and Stroke in Type 2 Diabetic Patients

Study Questions:

Are diabetics at increased risk of subclinical episodes of atrial fibrillation (AF) and stroke?


Four hundred sixty-four patients under the age of 60 years (mean age 52 years) with type 2 diabetes underwent 48-hour Holter monitoring at 3, 6, 9, and 12 months, then annually during a mean follow-up of 37 months. Magnetic resonance imaging (MRI) of the brain was performed at baseline. Patients known to have AF or a prior stroke were excluded, as were patients with comorbidities such as hypertension, coronary artery disease, cardiomyopathy, and sleep apnea. The control group consisted of 240 healthy subjects who were age- and gender-matched.


Subclinical episodes of AF were significantly more prevalent in the diabetic patients (9%) than in the control group (1.6%). Six percent of AF episodes lasted 10-60 minutes, 70% lasted 1-24 hours, and 24% lasted 1-2 days. Silent cerebral infarcts were found by MRI significantly more often among the diabetic patients with subclinical AF (61%) than among those without AF (29%). Strokes also were more prevalent among the diabetics with than without subclinical AF (17% vs. 6%, respectively). Subclinical AF was an independent predictor of silent cerebral infarction (odds ratio [OR], 4.4) and stroke (OR, 4.6) in the diabetic patients.


The authors concluded that diabetic patients have a higher prevalence of subclinical AF, and that this is associated with a greater risk of silent cerebral infarction and stroke.


The results suggest that it may be appropriate to screen diabetic patients with an event monitor and to anticoagulate those who are found to have AF.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, Atrial Fibrillation/Supraventricular Arrhythmias, Magnetic Resonance Imaging

Keywords: Stroke, Follow-Up Studies, Cerebral Infarction, Diabetes Mellitus, Type 2, Atrial Fibrillation, Magnetic Resonance Imaging

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