Key result
Atrial high-rate episodes lasting ≥2 minutes detected by dual chamber pacemakers were significantly associated with an increased risk of neurological events (HR 13.605).
Why the study?
Patients with AHRE are at higher risk of neurological events, but the optimal cutoff threshold for AHRE duration in dual chamber permanent pacemaker patients without prior AF remained to be identified.
Does an atrial high-rate episode duration of ≥2 minutes predict neurological events in patients with dual chamber permanent pacemakers without prior atrial fibrillation?
Cohort (n=355)
No
Does an atrial high-rate episode duration of ≥2 minutes predict neurological events in patients with dual chamber permanent pacemakers without prior atrial fibrillation?
Effect estimate: HR 13.605 (95% CI 3.010-61.498)
p-value: p=0.001
In patients with dual chamber permanent pacemakers without prior atrial fibrillation, an atrial high-rate episode duration of ≥2 minutes is an independent predictor of subsequent neurological events.
May support intensified monitoring in pacemaker patients without prior AF; leaves open whether anticoagulation improves outcomes.
Background Patients with atrial high‐rate episode (AHRE) are at higher risk of neurological events. This study aimed to identify the optimal cutoff threshold for AHRE duration in patients with dual chamber permanent pacemakers (PPM) without prior atrial fibrillation. Methods We included 355 consecutive patients receiving dual chamber pacemaker implantation. Primary outcome was composite endpoint of subsequent neurological events after various AHRE durations. AHRE was defined as >175 bpm (MEDTRONIC) or > 200 bpm (BIOTRONIK) for longer than 30 s. Cox regression analysis with time‐dependent covariates was conducted. Results The mean age of included patients was 75.6 ± 11.3 years. Among 355 included patients, some had multiple AHREs; 125 patients (35.2%) developed AHRE ≥2 min, 107 (30.1%) had ≥5 min, 55 (15.5%) had ≥6 h, and 37 (10.4%) had ≥24 h. The mean follow‐up was 42.1 ± 31.2 months. During follow‐up, 19 neurological events occurred. After adjustment for CHA 2 DS 2 ‐VASc score and device type, multivariate Cox regression analysis indicated AHRE ≥2 min (HR 13.605, 95% CI 3.010–61.498), and AHRE ≥5 min (HR 5.819, 95% CI 2.056–16.470) were significantly associated with neurological events. Hence, the optimal AHRE cutoff value was 2 min with the highest Youden index (sensitivity, 89.5%; specificity, 67.8%; AUC, 0.823, 95% CI, 0.763–0.884; p < 0.001). Conclusions Patients with dual chamber PPM who develop AHRE have increased risk of neurological events. Comprehensive assessment of the risks and benefits of prescribing anticoagulants should be considered in PPM patients with AHRE ≥2 min.
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Lu et al. (2021) conducted a cohort in Dual chamber permanent pacemakers without prior atrial fibrillation (n=355). Atrial high-rate episodes (AHRE) ≥ 2 min vs. AHRE < 2 min was evaluated on Neurological events (ischemic stroke or transient ischemic attack) (HR 13.605, 95% CI 3.010-61.498, p=0.001). Atrial high-rate episodes lasting ≥2 minutes detected by dual chamber pacemakers were significantly associated with an increased risk of neurological events (HR 13.605).
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