Prevalence and Predictors of Clinically Relevant Atrial High-Rate Episodes in Patients with Cardiac Implantable Electronic Devices

Abstract

Background and Objectives Atrial high-rate episodes (AHREs) can be continuously detected by cardiovascular implantable electronic devices (CIEDs); however, the predictors of clinically relevant AHREs are unclear. Methods This prospective multicenter study monitored 816 patients (median age 73 years, 40.4% male) without atrial fibrillation (AF) from September 2017 to July 2020. AHREs was defined as a programmed atrial detection rate >220 beats/min. The reference values of 6 minutes and 6 hours were set to analyze clinical implication of AHREs based on previously published data that the 6 minutes excluded most episodes of oversensing. Results During a median follow-up of 18 months (interquartile interval 9–26 months), AHREs with the longest durations of >15 seconds, >6 minutes, and >6 hours and clinically documented AF by electrocardiography were noted in 246 (30.1%), 112 (13.7%), 49 (6.0%), and 24 (2.9%) patients, respectively. Among patients developing AHREs >6 minutes, 102 (91.1%) of 112 patients were identified at the 6-month visit. Patients with AHREs >6 minutes had higher proportions of sick sinus syndrome, subjects with atrial premature beat >1% on Holter monitoring, and larger left atrium (LA) size than patients with AHREs ≤6 minutes. Multivariable logistic regression analysis showed that LA diameter >41 mm (odds ratio [OR], 2.08; 95% confidence interval [95% CI], 1.25–3.45), and sick sinus syndrome (OR, 3.22; 95% CI, 1.91–5.43) were associated with AHREs >6 minutes. Conclusions In patients with LA diameter >41 mm, and sick sinus syndrome before CIEDs implantation is associated with risk of developing AHREs >6 minutes. Trial Registration ClinicalTrials.gov Identifier: NCT03303872

Atrial high-rate episodes predict major adverse cardio/cerebrovascular events in patients with cardiac implantable electrical devices

“…Awareness of risk factors that contribute to the occurrence of AHRE ≥ 6 min ~ 24 h is clinically relevant to early prevention in CIEDs patients. Previous studies 17 – 19 identified several predictors for AHRE, and the common predictive factor in these studies was increased LA diameter 17 , 18 . A Korean study 17 demonstrated that LA > 41 mm was significantly associated with occurrence of AHRE ≥ 6 min, and an Indian study reported increased LA diameter contributed to prolonged AHRE 18 .…”

“…Previous studies 17 – 19 identified several predictors for AHRE, and the common predictive factor in these studies was increased LA diameter 17 , 18 . A Korean study 17 demonstrated that LA > 41 mm was significantly associated with occurrence of AHRE ≥ 6 min, and an Indian study reported increased LA diameter contributed to prolonged AHRE 18 . In the present study, increased LA diameter was consistently and significantly associated with AHRE ≥ 6 min to 24 h, comparable to results of the two studies mentioned before 17 , 18 .…”

“…A Korean study 17 demonstrated that LA > 41 mm was significantly associated with occurrence of AHRE ≥ 6 min, and an Indian study reported increased LA diameter contributed to prolonged AHRE 18 . In the present study, increased LA diameter was consistently and significantly associated with AHRE ≥ 6 min to 24 h, comparable to results of the two studies mentioned before 17 , 18 . Results suggest that, before implantation of CIEDs, evaluation of patients’ echocardiographic parameters must include measurement of LA size, which may lead to early prediction of AHRE ≥ 6 min—a strong predictor for subsequent AF and MACCE.…”

“…Reported independent predictors for AHRE occurrence include sick sinus syndrome 17 , increased left atrium (LA) diameter 17 , 18 , and paced QRS duration 18 . However, a meta-analysis of 28 studies including more than 24,000 patients 19 revealed that patients’ baseline characteristics were not associated with AHRE occurrence, or other factors, including advanced age, lower resting heart rate, diabetes, hypertension, stroke, thromboembolic events, congestive heart failure, increased LA diameter, coronary artery disease, and CHADS 2 scores.…”

Atrial High-Rate Event Incidence and Predictors in Patients With Permanent Pacemaker Implantation

“…Atrial enlargement is accompanied by different degrees of atrial fibrosis, and that atrial fibrosis may be an important characteristic of persistent AF (19). Kim et al (11) revealed that left atrium enlargement (>41 mm) was associated with AHRE occurrence (OR = 1.96; 95% CI, 1.00-3.85; and P = 0.050). The present study also revealed that the left atrium was significantly larger [38.0 mm [33.8-41.9 mm]] in group A than in group N [35.6 mm [32.8-38.9 mm]] (P = 0.009).…”