Key result
Sick sinus syndrome (OR 3.22) and left atrium diameter >41 mm (OR 2.08) were independently associated with the development of atrial high-rate episodes >6 minutes in patients with pacemakers.
Why the study?
Atrial high-rate episodes are continuously detected by CIEDs, but predictors of clinically relevant episodes remain unclear.
Observational (n=816)
Yes
Odds Ratio: 3.22 (95% CI 1.91–5.43)
p-value: p=<0.001
LA diameter and sick sinus syndrome warrant prospective validation as AHRE predictors; leaves open their utility in risk stratification.
BACKGROUND AND OBJECTIVES: Atrial high-rate episodes (AHREs) can be continuously detected by cardiovascular implantable electronic devices (CIEDs); however, the predictors of clinically relevant AHREs are unclear. METHODS: This prospective multicenter study monitored 816 patients (median age 73 years, 40.4% male) without atrial fibrillation (AF) from September 2017 to July 2020. AHREs was defined as a programmed atrial detection rate >220 beats/min. The reference values of 6 minutes and 6 hours were set to analyze clinical implication of AHREs based on previously published data that the 6 minutes excluded most episodes of oversensing. RESULTS: During a median follow-up of 18 months (interquartile interval 9-26 months), AHREs with the longest durations of >15 seconds, >6 minutes, and >6 hours and clinically documented AF by electrocardiography were noted in 246 (30.1%), 112 (13.7%), 49 (6.0%), and 24 (2.9%) patients, respectively. Among patients developing AHREs >6 minutes, 102 (91.1%) of 112 patients were identified at the 6-month visit. Patients with AHREs >6 minutes had higher proportions of sick sinus syndrome, subjects with atrial premature beat >1% on Holter monitoring, and larger left atrium (LA) size than patients with AHREs ≤6 minutes. Multivariable logistic regression analysis showed that LA diameter >41 mm (odds ratio [OR], 2.08; 95% confidence interval [95% CI], 1.25-3.45), and sick sinus syndrome (OR, 3.22; 95% CI, 1.91-5.43) were associated with AHREs >6 minutes. CONCLUSIONS: In patients with LA diameter >41 mm, and sick sinus syndrome before CIEDs implantation is associated with risk of developing AHREs >6 minutes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03303872.
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Kim et al. (2020) conducted an observational in Cardiac Implantable Electronic Devices (CIEDs) without prior atrial fibrillation (n=816). Sick sinus syndrome vs. Atrioventricular block was evaluated on Development of atrial high-rate episodes (AHREs) >6 minutes (OR 3.22, 95% CI 1.91-5.43, p=<0.001). Sick sinus syndrome (OR 3.22) and left atrium diameter >41 mm (OR 2.08) were independently associated with the development of atrial high-rate episodes >6 minutes in patients with pacemakers.