Echocardiographic Parameters of Atrial High-rate Episodes in Patients with Cardiac Implantable Electronic Devices

Background: Atrial high-rate episodes (AHREs) detected by cardiac implantable electronic devices (CIEDs) are associated with adverse cardiovascular outcomes, including atrial fibrillation and thromboembolism. This study aims to identify echocardiographic parameters of AHREs in patients with CIEDs and explore the diagnostic value of strain metrics and structural parameters. Patients and Methods: This cross-sectional study included 140 patients with CIEDs, divided into AHRE and non-AHRE groups. Comprehensive echocardiographic assessments, including left atrial (LA) strain and left ventricular (LV) parameters, were performed. ROC curve analysis was used to evaluate predictive accuracy. Univariate and multivariate logistic regression analyses identified independent parameters. Results: Patients with AHREs showed significant differences in echocardiographic parameters. Diastolic wall strain (DWS) was markedly reduced (0.29 ± 0.03 vs. 0.38 ± 0.05, P < 0.001). LA reservoir, conduit, and pump strain were significantly impaired in AHRE group ( P < 0.001). Their combined measure demonstrated the highest overall performance with area under curve (AUC) of 0.956, sensitivity of 95.71%, and specificity of 84.29%. Combining all three parameters (DWS, standard deviation of the time-to-peak strain during ventricular systole, and Standard deviation of the time-to-peak strain during late diastole [SDd]) maintained high diagnostic accuracy with AUC of 0.941, sensitivity of 97.14%, and specificity of 80%. Multivariate analysis identified DWS (OR = 0.727, P = 0.0045), LA diameter (OR = 2.454, P = 0.002), and diastolic strain variability (SDd, OR = 6.570, P < 0.001) as independent markers of the occurrence and burden of AHRE. Conclusions: Echocardiographic parameters, particularly DWS, LA strain metrics, and SDd, are important parameters in patients with AHREs. The integration of strain and structural metrics enhances diagnostic accuracy, offering valuable insights into AHRE pathophysiology.