antero-posterior çapları (LA-AP) (4.14 ± 0.33 vs. 3.90 ± 0.31, p< 0.01), sol atriyum volümleri (LAV) (31.92 ± 3.17 vs. 30.38 ± 3.15, p< 0.01) ve CHA2DS2-VASc skorları (2.29 ± 0.83 vs. 1.81 ± 0.76, p< 0.01) AYHE (-) hastalara göre daha yüksek bulundu. Yapılan çok değişkenli analizde artmış VKİ, istirahat kalp hızı, LA-AP ve CHA2DS2-VASc skorunun bağımsız olarak AYHE prediktörleri olduğu gösterildi. Sonuç: Artmış VKİ sadece semptomatik AF ile değil aynı zamanda cihaz tarafından saptanan sessiz AF epizodları ile ilişkilidir. Anahtar Kelimeler: Sessiz atriyal fibrilasyon; aseptomatik atriyal fibrilasyon; atriyal yüksek hız epizodları; obezite; artmış vücut kitle indeksi Emrah Bozbeyoğlu1 , Göksel Çinier2 1 İstanbul Dr. Siyami Ersek Cardiovascular Surgery Training and Research Hospital, Clinic of Cardiology, İstanbul, Turkey 2 Kaçkar State Hospital, Clinic of Cardiology, Rize, Turkey Increased Body Mass Index is Associated with Device Detected Silent Atrial Fibrillation Göksel Çinier E-mail: cinierg@gmail.com Submitted: 07.08.2018 Accepted: 13.10.2018 © Copyright 2018 by Koşuyolu Heart Journal. Available on-line at www.kosuyoluheartjournal.com 230 ORIGINAL INVESTIGATION ● Koşuyolu Heart J 2018;21(3):230-235 • DOI: 10.5578/khj.67510 Correspondence Bozbeyoğlu E, Çinier G. ● Koşuyolu Heart J 2018;21(3):230-235 231 INtroDUCTION Atrial fibrillation (AF) is the most common cardiac rhythm disorder in clinical practice and associated with significant morbidity and mortality, especially due to being the major cause of cardiac embolism(1). The age of the population and increase in the incidence of cardiac risk factors associated with AF, such as obesity and hypertension, are held responsible for this rising epidemic. Timely intervention to the modifiable risk factors and early detection of AF is of utmost importance since treatment strategies targeting the elimination of AF are limited and because recurrence rates following electrical/pharmacological cardioversion and pulmonary vein isolation are still considered to be high once AF develops. Screening for asymptomatic AF is reasonable, particularly in patients with a high risk for developing AF, to prevent devastating adverse outcomes of undiagnosed AF. In a recent meta-analysis, electrocardiographic (ECG) monitoring detected previously undiagnosed AF in 11.5% stroke survivors(2). Technological advances in cardiac implantable electronic devices (CIED) enabled clinicians to identify atrial high rate episodes (AHRE), which are surrogates for asymptomatic AF during routine device interrogation. Subsequent studies demonstrated that patients with AHRE have a considerably high risk for developing clinical AF, ischemic stroke, and death(3-5). In the light of these findings, the recent European guidelines on AF management recommend that pacemakers (PM) and implantable cardiac defibrillators should be interrogated on a regular basis for AHRE and that patients with AHRE should undergo further ECG monitoring to document AF with class IB indication(6). To identify patients who are more likely to develop AF is an important aspect for intervening modifiable risk factors associated with AF. Obesity has been demonstrated to be one such modifiable risk factor associated with an increased risk of incident AF in several studies(7,8). Progressive weight reduction was found to be associated with a reduction in AF burden and an increase in AF-free time interval in a long-term follow-up cohort(9). However, these studies have included only patients with clinically symptomatic AF. The association of increased body mass index (BMI) with silent AF remains unknown. In this report, we aimed to investigate the association between increased BMI with the occurrence of AHRE in patients with cardiac pacemaker. PATIENTS and METHODS Patients who underwent dual chamber PM implantation between January 2015 and February 2016 were included in this prospective study. In all cases, the choice of device manufacturer was left to the attending physician’s discretion. Exclusion criteria were: BMI < 18 kg/m2 , previous history of atrial arrhythmias, renal failure, valvular heart disease more than mild degree, and previous valvuloplasty procedure or valve replacement operation. All patients provided written informed consent for participation to the study protocol. The study was approved by the institutional ethical committee. Prior to PM implantation, demographical characteristics and medical history of study subjects were recorded. Patient’s weight and height were measured and recorded using a standardized protocol. The BMI was calculated as weight in kilograms divided by the square of height in meters (kg/m2 ). Patients were divided into 3 groups according to their baseline BMI’s as defined by World Health Organization guidelines: normal weight (BMI: 18- 25 kg/m2 ), overweight (BMI: 25-30 kg/m2 ), and obese (BMI: > 30 kg/m2 ) (10). Hypertension was defined as systolic blood pressure ≥ 140 mm/Hg, diastolic blood pressure ≥ 90 mm/Hg, or use of anti-hypertensive medical therapy. The criteria for the diagnosis of diabetes mellitus were fasting glucose level ≥ 126 mg/dL (7.0 mmol/L), random glucose level ≥ 200 mg/dL (11.1 mmol/L), or use of oral anti-diabetics/insulin injections to treat hyperglycemia. Patients were categorized as current smoker if they smoked ≥ 1 cigarette per day and current alcohol consumer if they