Atrial high\u2011rate episodes and risk of major adverse cardiovascular events in patients with dual chamber permanent pacemakers: a retrospective study

Wei-Da Lu,Ju-Yi Chen

doi:10.1038/s41598-021-85301-7

Abstract

Patients with atrial high-rate episodes (AHRE) are at higher risk of major adverse cardiovascular events (MACE). The cutoff threshold for AHRE duration for MACE, with/without history of atrial fibrillation (AF) or myocardial infarction (MI), is unknown. A total of 481 consecutive patients with/without history of AF or MI receiving dual-chamber pacemaker implantation were included. The primary outcome was a composite endpoint of MACE after AHRE ≥ 5 min, ≥ 6 h, and ≥ 24 h. AHRE was defined as > 175 bpm (MEDTRONIC) or > 200 bpm (BIOTRONIK) lasting ≥ 5 min. Cox regression analysis with time-dependent covariates was conducted. Patients’ mean age was 75.3 ± 10.7 years and 188 (39.1%) developed AHRE ≥ 5 min, 115 (23.9%) ≥ 6 h, and 83 (17.3%) ≥ 24 h. During follow-up (median 39.9 ± 29.8 months), 92 MACE occurred (IR 5.749%/year, 95% CI 3.88–5.85). AHRE ≥ 5 min (HR 5.252, 95% CI 2.575–10.715, P < 0.001) and ≥ 6 h (HR 2.548, 95% CI 1.284–5.058, P = 0.007) was independently associated with MACE, but not AHRE ≥ 24 h. Patients with history of MI (IR 17.80%/year) had higher MACE incidence than those without (IR 3.77%/year, p = 0.001). Significant differences were found between MACE patients with/without history of AF in AHRE ≥ 5 min but not AHRE ≥ 6 h or ≥ 24 h. Patients with dual-chamber pacemakers who develop AHRE have increased risk of MACE, particularly after history of AF or MI.

Highlights

Atrial fibrillation (AF) is a common arrhythmia encountered in clinical practice and is a major cause of preventable thromboembolic disease, namely stroke or systemic embolism[1]
We found that hypertension, hyperlipidemia, history of AF, chronic kidney disease, and increased left atrial (LA) diameter were all significantly associated with the occurrence of atrial high-rate episodes (AHRE)
We found that in patients with history of myocardial infarction (MI), only those with AHRE ≥ 5 min were independently associated with major adverse cardiovascular events (MACE), and for those without history of MI, AHRE ≥ 5 min, ≥ 6 h and ≥ 24 h were all independently associated with MACE

Summary

Introduction

Atrial fibrillation (AF) is a common arrhythmia encountered in clinical practice and is a major cause of preventable thromboembolic disease, namely stroke or systemic embolism[1]. The increased use of cardiac implantable electronic devices (CIEDs) has provided the technical ability to monitor atrial rhythm long term, and recent studies have focused on subclinical AF or atrial high-rate episodes (AHRE) detected by CIEDs, even in asymptomatic patients. Results of some studies have demonstrated that AHRE is associated with an increased risk of thromboembolic events[2]. Increased risk of major adverse cardiovascular events (MACE) have been studied in patients with A F3 and occasionally those with AHRE4.

Methods

Results

Discussion

Conclusion