Abstract
Abstract Background The occurrence of high atrial rate episodes (AHRE) is growing in importance due to the increasing number of patients with implantable cardiac electronic devices (CIED). As a result, clinicians need to balance the benefits of a pharmacological therapy against the risks involved. To date, there are no clear evidence on the long–term effects of AHRE, nor are there any specific recommendations to help physicians make the most appropriate treatment choice. Methods We enrolled 732 patients with CIED followed in the Arrhythmology department of San Filippo Neri Hospital, in Rome and with remote home monitoring. Only patients with single–chamber, dual–chamber and biventricular pacemakers (CRT–P) were included. All patients had post–implantation follow–up at 6 months and one year. The minimum follow–up duration considered was 24 months. Patients with permanent pre–implant atrial fibrillation were excluded. Results Among the enrolled cohort, AHRE were found in 170 (23.2%) patients. The occurrence of AHRE was significantly related to older age (p = 0.001 HR 1.02 CI 95%), lower ejection fraction (p = 0.027 HR 0.98 CI 95%) and severe mitral valvulopathy (p = 0.003 HR 1.7 CI 95%). The presence of AHRE increased the risk of cryptogenic stroke only for episodes over 24 hours (p = 0.02 HR 1.6 CI 95%) and increased mortality (HR 1.32 CI 95%), although not significantly (p = 0.132). Conclusion AHRE are associated with adverse events and may increase mortality in patients with CIED. Their monitoring and detection is necessary for an appropriate management of treatments. Randomised studies are needed to clarify the criteria for thromboembolic prevention in the context of AHRE.
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