Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 19;17(6):e86376.
doi: 10.7759/cureus.86376. eCollection 2025 Jun.

Clinical- and Device-Related Factors Associated With Atrial High Rate Episodes in Patients With Dual-Chamber Pacemakers

Frank Jorge Valdez Baez  1 , Elaine Nuñez Ayala  1 , Juanico Cedano Ramirez  1 , Cemirame Payan Jimenez  1 , Catherine Merejo Peña  1 , Laura Valdez de Leon  1 , Warenny Montero Morillo  1 , Evelina Severino Marte  1 , Pedro Vidal Corniel Martinez  2
Affiliations

Clinical- and Device-Related Factors Associated With Atrial High Rate Episodes in Patients With Dual-Chamber Pacemakers

Frank Jorge Valdez Baez et al. Cureus. .

Abstract

Introduction Atrial high-rate episodes (AHREs) detected by dual-chamber pacemakers may represent subclinical precursors of atrial fibrillation and thromboembolic events. However, the clinical-, electrocardiographic-, and device-related characteristics distinguishing patients with and without AHREs are not fully defined. This study aimed to compare these variables between both groups to identify those independently associated with the presence of AHREs. Methods This retrospective, single-center observational study included ambulatory patients with dual-chamber pacemakers evaluated between June and December 2024. Clinical, electrocardiographic, and device-related variables were compared between patients with and without AHREs. Bivariate analyses were conducted to identify significant differences, and multivariable logistic regression was used to determine variables independently associated with the presence of AHREs. Results A total of 450 individuals were included, of whom 185 (41.1%) exhibited AHREs, compared to 265 (58.9%) without AHREs, those affected were more frequently female, 116 (62.7%) versus 140 (52.8%), p = 0.037, and had a higher prevalence of prior atrial fibrillation or atrial tachycardia, 98 (53.0%) versus 68 (25.7%), p < 0.001. Ventricular pacing was slightly lower in the AHRE group (median 98% vs. 99%; p = 0.016), and atrial pacing mode with switch to dual-chamber (AAI-DDD) pacing mode was more common, 44 (23.8%) versus 32 (12.1%), p = 0.001. In multivariable analysis, prior atrial arrhythmias (OR 2.95; p < 0.001), follow-up ≥ 90 days (OR 4.14; p = 0.012), female sex (OR 1.63; p = 0.020), and AAI-DDD pacing (OR 1.92; p = 0.027) were independently associated with AHREs. The model demonstrated acceptable discrimination (area under the curve (AUC) = 0.70). Conclusion In this cohort, AHREs were observed in 41.1% of participants. Their occurrence was significantly associated with female sex, a prior history of atrial fibrillation or atrial tachycardia, a follow-up duration of 90 days or more, reduced ventricular pacing, and the use of the AAI-DDD pacing mode.

Keywords: anticoagulation; arrhythmias; atrial fibrillation; atrial high-rate episodes; dual-chamber pacemakers; low-income countries; pacing strategy; subclinical atrial arrhythmias.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee of the Asociación Instituto Dominicano de Cardiología issued approval AIDC-CE-2025-001. This study was approved by the Ethics Committee of the Asociación Instituto Dominicano de Cardiología (AIDC) under approval number AIDC-CE-2025-001 and was conducted in accordance with the ethical principles of the Declaration of Helsinki. Analyses were performed without discrimination based on sex. Given the observational and retrospective nature of the study, informed consent was not required, as only previously recorded data were used and no direct interaction with patients occurred. All data were handled with strict confidentiality and anonymized in compliance with international data protection regulations. . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. ROC Curve for the Multivariable Logistic Regression Model Predicting Atrial High-Rate Episodes (AHREs)
The ROC curve displays the discriminatory performance of the multivariable logistic regression model predicting AHREs, with an AUC of 0.70 (95% CI, 0.66-0.75). Details of the model variables and statistics are provided in Table 5. AUC: area under the curve; AHREs: atrial high-rate episodes; ROC: receiver operating characteristic
See this image and copyright information in PMC

References

    1. 2023 ACC/AHA/ACCP/hrs guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Joglar JA, Chung MK, Armbruster AL, et al. Circulation. 2024;149:0. - PMC - PubMed
    1. Subclinical atrial fibrillation and the risk of stroke. Healey JS, Connolly SJ, Gold MR, et al. N Engl J Med. 2012;366:120–129. - PubMed
    1. Atrial high-rate episodes: prevalence, stroke risk, implications for management, and clinical gaps in evidence. Bertaglia E, Blank B, Blomström-Lundqvist C, et al. Europace. 2019;21:1459–1467. - PMC - PubMed
    1. The incidence and risk factors of atrial high-rate episodes in patients with a dual-chamber pacemaker. Le Nguyen SK, Kieu DN, Tran PL, et al. J Arrhythm. 2024;40:1158–1164. - PMC - PubMed
    1. Clinical characteristics and prevalence of atrial high-rate episodes in patients with cardiac implantable electronic devices. Jaroonpipatkul S, Sathapanasiri T, Maliang C, Pokawattana A, Navaravong L. Cureus. 2024;16:0. - PMC - PubMed

LinkOut - more resources