A daily atrial high-rate episode burden ≥6 minutes in patients without prior AF was associated with an increased risk of major cardiovascular events (HR 4.9; 95% CI 2.19-10.91; p<0.001).
RCT (n=1,160)
Does an AHRE daily burden ≥6 minutes increase the risk of cardiovascular death, heart failure hospitalization, and stroke in patients with sinus node dysfunction and dual-chamber pacemakers or defibrillators?
A daily AHRE burden of ≥6 minutes is associated with a nearly 5-fold increased risk of major cardiovascular events in pacemaker/defibrillator patients without prior atrial fibrillation.
Effect estimate: HR 4.9 (95% CI 2.19-10.91)
p-value: p=<0.001
BACKGROUND The clinical significance of device-detected atrial high-rate episodes (AHREs) is believed to increase with AHRE burden. OBJECTIVE This study evaluated whether a daily burden ≥6 minutes is associated with major cardiovascular outcomes. METHODS We analyzed 1160 patients with sinus node dysfunction and dual-chamber pacemakers or defibrillators from the B3 randomized trial, followed for 3 years. The primary composite endpoint included cardiovascular death, worsening heart failure hospitalization (WHFH), and stroke or transient ischemic attack (TIA). Secondary endpoints were individual components of the primary endpoint and progression to long-lasting AF. Using competing-risk survival models with AHRE burden as a time-varying covariate, we calculated CHA2DS2-VASc-adjusted hazard ratios (HRs) after the first day with burden ≥6 minutes. AHREs were all adjudicated. RESULTS AHRE burden ≥6 minutes occurred in 52.5% of patients, 47.1% of whom had no prior AF. There were 65 primary events (10 cardiovascular deaths, 39 WHFHs, 16 strokes/TIAs). In patients without prior AF, AHRE burden ≥6 minutes was significantly associated with the primary endpoint (HR 4.9; 95% CI, 2.19-10.91; p4-fold increased risk of major cardiovascular events, mainly driven by cardiovascular death, WHFH, and progression to long-lasting AF. No such association was observed in patients with prior AF.
Botto et al. (Sun,) conducted a rct in Sinus node dysfunction and dual-chamber pacemakers or defibrillators (n=1,160). Atrial high-rate episodes (AHRE) daily burden ≥6 minutes vs. No AHRE burden ≥6 minutes was evaluated on Composite of cardiovascular death, worsening heart failure hospitalization (WHFH), and stroke or transient ischemic attack (TIA) (HR 4.9, 95% CI 2.19-10.91, p=<0.001). A daily atrial high-rate episode burden ≥6 minutes in patients without prior AF was associated with an increased risk of major cardiovascular events (HR 4.9; 95% CI 2.19-10.91; p<0.001).