Key result
Elevated homocysteine predicts atrial high-rate episodes in AF-naïve CIED patients with ~34% incidence.
Why the study?
Early rhythm control in AF improves clinical outcomes and requires early detection, and atrial high-rate episodes in CIEDs are a known AF risk factor. This study investigated clinical, biomarker, and genetic predictors and the prognosis of AHRE in AF-naïve patients with a CIED.
Do clinical factors, biomarkers (such as homocysteine), and single nucleotide polymorphisms predict atrial high-rate episodes in patients without prior atrial fibrillation undergoing cardiac implantable electronic device implantation?
Cohort (n=95)
Do clinical factors, biomarkers (such as homocysteine), and single nucleotide polymorphisms predict atrial high-rate episodes in patients without prior atrial fibrillation undergoing cardiac implantable electronic device implantation?
Elevated homocysteine levels (>10.4 µmol/L) and clinical factors such as sick sinus syndrome may help predict atrial high-rate episodes in AF-naïve patients with CIEDs, facilitating early AF detection.
Answers are grounded in this paper and cite their sources.
May aid AHRE risk stratification in CIED patients without AF; hypothesis-generating and requires prospective validation.
BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) is the most common arrhythmia requiring treatment. Early rhythm control improves clinical outcomes, emphasizing the need for early AF detection. Atrial high-rate episodes (AHRE) reported in cardiac implantable electronic devices (CIED) are a known risk factor for AF. We investigated the prognosis and predictors of AHRE, including clinical factors, biomarkers, and single nucleotide polymorphisms (SNPs), in AF-naïve patients with CIED. METHODS: Ninety-five patients without a prior history of AF who underwent CIED implantation were enrolled. Characteristics, laboratory data, and 5 SNPs were analyzed. AHRE were defined as atrial rates ≥170 bpm lasting ≥30 seconds. RESULTS: AHRE occurred in 33.7% of patients during a mean follow-up of 504 days, primarily among those with sick sinus syndrome. Homocysteine levels were significantly higher in the AHRE group (14.0 vs. 11.5 µmol/L, p=0.015). The optimal predictive cut-off was 10.4 µmol/L (area under the curve=0.698, p=0.002). CONCLUSIONS: Early AHRE detection may enable timely AF diagnosis. Clinical factors, biomarkers, and genetic variants may help predict AHRE occurrence. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05475860.
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Ahn et al. (2026) conducted a cohort in Cardiac implantable electronic device (CIED) implantation without prior history of atrial fibrillation (n=95). Clinical factors, biomarkers (homocysteine), and 5 single nucleotide polymorphisms (SNPs) vs. Patients who did not develop atrial high-rate episodes (AHRE) was evaluated on Atrial high-rate episodes (AHRE), defined as atrial rates ≥170 bpm lasting ≥30 seconds (AUC 0.698, p=0.002). Homocysteine levels ≥10.4 µmol/L predicted atrial high-rate episodes (33.7% incidence; 14.0 vs 11.5 µmol/L, p=0.015; AUC=0.698, p=0.002) in AF-naïve CIED patients.
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