Key result
A longest baseline atrial high-rate episode lasting 12 to under 24 hours was independently associated with an increased risk of developing clinical atrial fibrillation or episodes lasting ≥24 hours (HR 8.15).
Why the study?
Atrial high-rate episodes detected by CIEDs may be associated with progression toward long-lasting episodes (>=24 h) and clinical AF, but patient characteristics, adverse event incidence, and predictors remained to be described.
Cohort (n=104)
No
Hazard Ratio: 8.15 (95% CI 2.32–28.65)
In patients with CIED-detected AHRE, higher baseline CHA2DS2-VASc score and longer AHRE duration (12-24 hours) strongly predict progression to clinical AF or long-lasting AHRE episodes.
Background. Atrial high rate episodes (AHRE) detected by cardiac implantable electronic devices (CIEDs) may be associated with a risk of progression towards long-lasting episodes (≥24 h) and clinical atrial fibrillation (AF). Methods. Consecutive CIED patients presenting AHRE (with confirmation of an arrhythmia lasting 5 min–23 h 59 min, atrial rate ≥175/min, with no AF at 12-lead ECG and no prior clinical AF) were retrospectively enrolled. The aims of this study were to describe patients’ characteristics and the incidence of adverse events, and second, to identify potential predictors of the composite outcome of clinical AF and/or AHRE episodes lasting ≥24 h. Results. 104/107 (97.2%) patients (median age 79.7 (74.0–84.2), 33.7% female) had available follow-up data. Over a median follow-up of 24.3 (10.6–40.3) months, 31/104 (29.8%) patients experienced the composite outcome of clinical AF or AHRE episodes lasting ≥24 h. Baseline CHA2DS2-VASc score and the longest AHRE episode at enrollment lasting 12 h–23 h 59 min were independently associated with the composite outcome (Hazard ratio (HR); 95% CI: 1.40; 1.07–1.83 and HR: 8.15; 95% CI 2.32–28.65, respectively). Baseline CHA2DS2-VASc score and the longest AHRE episode at enrollment lasting 12 h–23 h 59 min were the only independent predictors of incident clinical AF (HR: 1.45; 95% CI 1.06–2.00 and HR: 4.25; 95% CI 1.05–17.20, respectively). Conclusions. In patients with AHRE, the incidence of clinical AF or AHRE episodes lasting ≥24 h is high in a two-year follow-up. Baseline patients’ characteristics (CHA2DS2-VASc score) and AHRE duration may help to intensify monitoring and decision-making, being independently associated with clinical AF at follow-up.
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Imberti et al. (2022) conducted a cohort in Atrial High-Rate Episodes (AHRE) (n=104). Longest AHRE episode lasting 12 h–23 h 59 min vs. Shorter AHRE episodes (<12 h) was evaluated on Composite of clinical atrial fibrillation or AHRE episodes lasting ≥24 h (HR 8.15, 95% CI 2.32-28.65). A longest baseline atrial high-rate episode lasting 12 to under 24 hours was independently associated with an increased risk of developing clinical atrial fibrillation or episodes lasting ≥24 hours (HR 8.15).
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