Key result
In patients with cardiac implantable electronic devices, the presence of newly detected atrial high-rate episodes was independently associated with an increased risk of worsening heart failure (HR 1.27).
Why the study?
The relationship between atrial high-rate episode burden and heart failure risk was unclear.
Does a higher burden of device-detected atrial high-rate episodes predict future heart failure events in patients with cardiac implantable electronic devices?
Cohort (n=104)
No
Does a higher burden of device-detected atrial high-rate episodes predict future heart failure events in patients with cardiac implantable electronic devices?
Hazard Ratio: 1.27 (95% CI 1.11–1.5)
Absolute Event Rate: 23.5% vs 5.7%
p-value: p=0.004
In patients with cardiac implantable electronic devices and no prior history of atrial fibrillation, a higher burden of device-detected atrial high-rate episodes is independently associated with an increased risk of future worsening heart failure.
Device-detected atrial high-rate episodes signal higher HF risk in CIED patients; hypothesis-generating, prospective trials needed before practice change.
BACKGROUND: The relationship between atrial high-rate episode (AHRE) burden (i.e., the frequency of atrial tachyarrhythmia) and heart failure (HF) risk is unclear. We hypothesized that new-onset and higher burden of AHRE are associated with HF. METHODS AND RESULTS: We included 104 consecutive patients with cardiac implantable electronic devices (CIEDs) capable of continuous atrial rhythm monitoring. Patients with AF history were excluded. To stratify patients, AHREs were evaluated only during the initial 1 year after CIED implantation. The primary endpoint was all-cause death or new-onset or worsening HF that required unplanned hospitalization or readjustment of HF drug therapy. At 1 year after CIED implantation, 34/104 patients (33%) exhibited AHREs. No difference in basal clinical characteristics except for left ventricular ejection fraction between patients with and without new-onset AHREs was found. AHRE groups had more HF events than the non-AHRE group. All patients were divided into 3 groups based on AHRE burden: none, low, and high. Worsening HF was observed in 12 patients (12%). Cox hazard analysis revealed that AHRE and higher AHRE burden were independent predictive factors for worsening HF. The high group showed a higher risk for HF than the non-AHRE groups, but no significant difference was found between the low- and non-AHRE groups. CONCLUSIONS: New-onset higher AHRE burden was associated with subsequent risk for HF in patients with CIEDs.
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Nishinarita et al. (2019) conducted a cohort in Patients with cardiac implantable electronic devices (CIEDs) without prior atrial fibrillation (n=104). Atrial high-rate episodes (AHREs) vs. No AHREs was evaluated on Worsening heart failure (HR 1.27, 95% CI 1.11-1.5, p=0.004). In patients with cardiac implantable electronic devices, the presence of newly detected atrial high-rate episodes was independently associated with an increased risk of worsening heart failure (HR 1.27).
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