Key result
Atrial high-rate episodes ≥6 minutes predict ~113% greater MACE risk in pacemaker patients without prior AF.
Why the study?
Device-detected AHRE increases MACE risk, but the predictive value of combining the R2CHA2DS2-VASc score with AHRE ≥ 6 min in dual-chamber PPM patients without prior AF remained to be evaluated.
Does the combination of the R2CHA2DS2-VASc score and AHRE ≥ 6 minutes improve prognostic stratification for MACE in patients with dual-chamber pacemakers and no prior AF?
Cohort (n=376)
No
Does the combination of the R2CHA2DS2-VASc score and AHRE ≥ 6 minutes improve prognostic stratification for MACE in patients with dual-chamber pacemakers and no prior AF?
Effect estimate: HR 2.125 (95% CI 1.162-3.887)
Absolute Event Rate: 23.3% vs 7.8%
p-value: p=0.014
The combination of the R2CHA2DS2-VASc score and device-detected atrial high-rate episodes ≥ 6 minutes significantly improves prognostic stratification for major adverse cardiovascular events in pacemaker patients without prior atrial fibrillation.
May refine MACE stratification with R2CHA2DS2-VASc in pacemaker patients; leaves open prospective validation and therapeutic implications.
Patients with device detected atrial high-rate episodes (AHRE) have an increased risk of MACE. The R 2 CHA 2 DS 2 -VASc, CHADS 2 , R 2 CHADS 2 and CHA 2 DS 2 -VASc score have been investigated for predicting major adverse cardiovascular events (MACE) in different groups of patients. We aimed to evaluate the R 2 CHA 2 DS 2 -VASc score in combination with AHRE ≥ 6 min for predicting MACE in patients with dual-chamber PPM but no prior atrial fibrillation (AF). We retrospectively enrolled 376 consecutive patients undergoing dual-chamber PPM implantation and no prior AF. The primary endpoint was subsequent MACE. For all patients in the cohort, CHADS 2 , R 2 CHADS 2 , CHA 2 DS 2 -VASc, R 2 CHA 2 DS 2 -VASc scores and AHRE ≥ or < 6 min were determined. AHRE was recorded as a heart rate > 175 bpm (Medtronic) or > 200 bpm (Biotronik) lasting ≥ 30 s. Multivariate Cox regression analysis with time-dependent covariates was used to determine the independent predictors of MACE. ROC-AUC analysis was performed for CHADS 2 , R 2 CHADS 2 , CHA 2 DS 2 -VASc, and R 2 CHA 2 DS 2 -VASc scores and then adding AHRE ≥ 6 min to the four scores. The median age was 77 years, and 107 patients (28.5%) developed AHRE ≥ 6 min. After a median follow-up of 32 months, 46 (12.2%) MACE occurred. Multivariate Cox regression analysis showed that R 2 CHA 2 DS 2 -VASc score (HR, 1.485; 95% CI, 1.212–1.818; p < 0.001) and AHRE ≥ 6 min (HR, 2.125; 95% CI, 1.162–3.887; p = 0.014) were independent predictors for MACE. The optimal R 2 CHA 2 DS 2 -VASc score cutoff value was 4.5 (set at ≥ 5), with the highest Youden index (AUC, 0.770; 95% CI, 0.709–0.831; p < 0.001). ROC-AUC analysis of the four risk scores separately combined with AHRE ≥ 6 min all showed better discriminatory power than the four scores alone (All Z -statistic p < 0.05). In patients with PPM who develop AHRE ≥ 6 min, it is crucial to perform risk assessment with either four scores to further stratify risk for MACE.
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Li et al. (2023) conducted a cohort in Dual-chamber permanent pacemaker patients with no prior atrial fibrillation (n=376). Atrial high-rate episodes (AHRE) ≥ 6 min vs. AHRE < 6 min was evaluated on Major adverse cardiovascular events (MACE) (HR 2.125, 95% CI 1.162-3.887, p=0.014). In patients with dual-chamber pacemakers and no prior atrial fibrillation, atrial high-rate episodes ≥ 6 minutes independently predicted major adverse cardiovascular events (HR 2.125).
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