Atrial High-Rate Episodes Detected by Cardiac Implantable Electronic Devices: Dynamic Changes in Episodes and Predictors of Incident Atrial Fibrillation

Abstract

Background. Atrial high rate episodes (AHRE) detected by cardiac implantable electronic devices (CIEDs) may be associated with a risk of progression towards long-lasting episodes (≥24 h) and clinical atrial fibrillation (AF). Methods. Consecutive CIED patients presenting AHRE (with confirmation of an arrhythmia lasting 5 min–23 h 59 min, atrial rate ≥175/min, with no AF at 12-lead ECG and no prior clinical AF) were retrospectively enrolled. The aims of this study were to describe patients’ characteristics and the incidence of adverse events, and second, to identify potential predictors of the composite outcome of clinical AF and/or AHRE episodes lasting ≥24 h. Results. 104/107 (97.2%) patients (median age 79.7 (74.0–84.2), 33.7% female) had available follow-up data. Over a median follow-up of 24.3 (10.6–40.3) months, 31/104 (29.8%) patients experienced the composite outcome of clinical AF or AHRE episodes lasting ≥24 h. Baseline CHA2DS2-VASc score and the longest AHRE episode at enrollment lasting 12 h–23 h 59 min were independently associated with the composite outcome (Hazard ratio (HR); 95% CI: 1.40; 1.07–1.83 and HR: 8.15; 95% CI 2.32–28.65, respectively). Baseline CHA2DS2-VASc score and the longest AHRE episode at enrollment lasting 12 h–23 h 59 min were the only independent predictors of incident clinical AF (HR: 1.45; 95% CI 1.06–2.00 and HR: 4.25; 95% CI 1.05–17.20, respectively). Conclusions. In patients with AHRE, the incidence of clinical AF or AHRE episodes lasting ≥24 h is high in a two-year follow-up. Baseline patients’ characteristics (CHA2DS2-VASc score) and AHRE duration may help to intensify monitoring and decision-making, being independently associated with clinical AF at follow-up.

Ventricular and Atrial Remodeling after Transcatheter Edge-to-Edge Repair: A Pilot Study

“…It can be speculated that the lack of significant improvement in LA function in the AF cohort may be due to a higher degree of atrial cardiomyopathy, which prevented reverse remodeling. Indeed, AF promotes and sustains a vicious circle of atrial electrical and structural remodeling, possibly leading to "domestication" of the arrythmia and derangement in atrial volumes, geometry, function, and cellular structure [27][28][29]. Furthermore, the small sample size and the high number of patients in AF at baseline compared to previous studies could explain the limited extent of reverse remodeling [26].…”

Long duration of atrial high‐rate episode is more favorable in predicting ischemic stroke than high CHA2DS2‐VASc score

“…It suggested that the duration of AHRE determined the risk of thromboembolism more than the numbers of the AHRE. 11 There was a study showing that the risk of thromboembolic events was less than 1% in the patients with AF duration of less than 48 h. 21 The length of AF duration associated with the stroke risk. 22 factors with an AHRE burden > 5.5 h/day for stroke prevention.…”

“…Cardiac implanted electronic device (CIED) can monitor fully quantified atrial high‐rate episode (AHRE). There are a lot of evidence to prove that AHRE represent the occurrence of AF 7–14 . Studies have shown a two‐fold increased risk of thrombotic events in patients with AHRE detected by CIEDs 6,8 .…”

Atrial fibrillation post-coronary or cardiac surgery: A transient inflammation-related event or the expression of a pre-existing arrhythmogenic atrial substrate?

“…This may vary and range from the duration of monitoring with telemetry, execution of 12-lead ECG at standardized time intervals after surgery, up to the planning of intermittent Holter recordings, or even continuous monitoring through implanted devices, further enhanced by remote monitoring functions [11]. In the latter context, indeed, it is known that episodes of atrial tachyarrhythmia lasting a few minutes are commonly detected by cardiac implantable electronic devices and may progress to clinical AF in up to 30% of patients at 2-year follow-up [12,13]. Since AF is strictly linked to a variety of factors (Figure 1), such as patients' age and a variable combination of cardiac substrate, triggers, precipitating factors, and altered autonomic modulation, it appears that, in this context, individualized decision-making is needed also with regard to indication for long-term OAC and extent of monitoring for patients in whom anticoagulation is not established or is prescribed for a limited period after surgery [14].…”