Characteristics of patients with atrial high rate episodes detected by implanted defibrillator and resynchronization devices

• Published in: Europace (London, England) Vol. 24; no. 3; pp. 375 - 383
• Main Authors: Miyazawa, Kazuo, Pastori, Daniele, Martin, David T, Choucair, Wassim K, Halperin, Jonathan L, Lip, Gregory Y H
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 02-03-2022
• Subjects: Aged; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - therapy; Clinical Research; Defibrillators; Heart Atria; Humans; Risk Factors; Stroke - epidemiology; Thromboembolism - epidemiology; Thromboembolism - etiology; Thromboembolism - prevention & control; Cardiac implantable electronic device; Stroke; Clinical profile; Atrial high rate episode; Thromboembolism; Atrial fibrillation
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euab186

Abstract
Aims
Atrial high rate episodes (AHREs) are associated with increased risks of thromboembolism and cardiovascular mortality. However, the clinical characteristics of patients developing AHRE of various durations are not well studied.
Methods and results
This was an ancillary analysis of the multicentre, randomized IMPACT trial. In the present analysis, we classified patients according to the duration of AHRE ≤6 min, >6 min to ≤6 h, >6 to ≤24 h and >24 h, and investigated the association between clinical factors and the development of each duration of AHRE. Of 2718 patients included in the trial, 945 (34.8%) developed AHRE. The incidence rates of each AHRE duration category were 5.4/100, 12.0/100, 6.8/100, and 3.3/100 patient-years, respectively. The incidence rates of AHRE >6 h were significantly higher in patients at high risk of thromboembolism (CHADS2 score ≥3) compared to those at low risk (CHADS2 score 1 or 2). Using Cox regression analysis, age ≥65 years and history of atrial fibrillation (AF) and/or atrial flutter (AFL) were risk factors for AHRE >6 min. In addition, hypertension was associated with AHRE >24 h (hazard ratio 2.13, 95% confidence interval 1.24–3.65, P = 0.006).
Conclusion
Atrial high rate episode >6 min to ≤6 h were most prevalent among all AHRE duration categories. Longer AHREs were more common in patients at risk of thromboembolism. Age and history of AF/AFL were risk factors for AHRE >6 min. Furthermore, hypertension showed a strong impact on the development of AHRE >24 h rather than age.