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Randomized Controlled Trial
. 2022 Mar 2;24(3):375-383.
doi: 10.1093/europace/euab186.

Characteristics of patients with atrial high rate episodes detected by implanted defibrillator and resynchronization devices

Kazuo Miyazawa  1 , Daniele Pastori  2   3 , David T Martin  4 , Wassim K Choucair  5 , Jonathan L Halperin  6 , Gregory Y H Lip  3   7 ; IMPACT Study Investigators
Affiliations
Randomized Controlled Trial

Characteristics of patients with atrial high rate episodes detected by implanted defibrillator and resynchronization devices

Kazuo Miyazawa et al. Europace. .

Abstract

Aims: Atrial high rate episodes (AHREs) are associated with increased risks of thromboembolism and cardiovascular mortality. However, the clinical characteristics of patients developing AHRE of various durations are not well studied.

Methods and results: This was an ancillary analysis of the multicentre, randomized IMPACT trial. In the present analysis, we classified patients according to the duration of AHRE ≤6 min, >6 min to ≤6 h, >6 to ≤24 h and >24 h, and investigated the association between clinical factors and the development of each duration of AHRE. Of 2718 patients included in the trial, 945 (34.8%) developed AHRE. The incidence rates of each AHRE duration category were 5.4/100, 12.0/100, 6.8/100, and 3.3/100 patient-years, respectively. The incidence rates of AHRE >6 h were significantly higher in patients at high risk of thromboembolism (CHADS2 score ≥3) compared to those at low risk (CHADS2 score 1 or 2). Using Cox regression analysis, age ≥65 years and history of atrial fibrillation (AF) and/or atrial flutter (AFL) were risk factors for AHRE >6 min. In addition, hypertension was associated with AHRE >24 h (hazard ratio 2.13, 95% confidence interval 1.24-3.65, P = 0.006).

Conclusion: Atrial high rate episode >6 min to ≤6 h were most prevalent among all AHRE duration categories. Longer AHREs were more common in patients at risk of thromboembolism. Age and history of AF/AFL were risk factors for AHRE >6 min. Furthermore, hypertension showed a strong impact on the development of AHRE >24 h rather than age.

Keywords: Atrial fibrillation; Atrial high rate episode; Cardiac implantable electronic device; Clinical profile; Stroke; Thromboembolism.

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Figures

Figure 1
Figure 1
The distribution of patients with CIED according to the risk scores [(A) CHADS2 score and (B) CHA2DS2-VASc score]. AHRE, atrial high rate episode.
Figure 2
Figure 2
The cumulative incidence of different burden of AHRE using the Kaplan–Meier method. AHRE, atrial high rate episode.
Figure 3
Figure 3
Clinical factors associated with the development of each burden of AHRE [(A) AHRE <6 min, (B) 6 min < AHRE ≤ 6 h, (C) 6 h < AHRE ≤ 24 h, and (D) AHRE > 24 h]. ACE-I, angiotensin-converting enzyme inhibitor; AF, atrial fibrillation; AFL, atrial flutter; ARB, angiotensin II receptor blocker; CI, confidence interval; CM, cardiomyopathy; HR, hazard ratio; TIA, transient ischaemic attack.
Figure 3d
Figure 3d
See this image and copyright information in PMC

Comment in

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