Korean Circ J.  2021 Mar;51(3):235-247. 10.4070/kcj.2020.0393.

Prevalence and Predictors of Clinically Relevant Atrial High-Rate Episodes in Patients with Cardiac Implantable Electronic Devices

• Kim M
• Kim TH
• Yu HT
• Choi EK
• Park HS
• Park J
• Lee YS
• Kang KW
• Shim J
• Sung JH
• Oh IY
• Joung B
• the AF-Pacemaker Study Group

• KMID: 2513521
• DOI: http://doi.org/10.4070/kcj.2020.0393

Abstract

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.

Keyword

Arrhythmia; Pacemaker; artificial; Sick sinus syndrome; Left atrium

Figure

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  Figure 1 Flow diagram showing study participants.AF = atrial fibrillation; AFL = atrial flutter; AHRE = atrial high rate episode; AV = atrioventricular.

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  Figure 2 Distributions of cardiac implantable electronic device-detected AHREs, and clinical AF during study period.AF = atrial fibrillation; AHRE = atrial high rate episode.

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