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Atrial high-rate episodes and risk of major adverse cardiovascular events in patients with cardiac implantable electronic devices

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Abstract

Background

Patients with atrial high-rate episodes (AHREs) are at higher risk of thromboembolic events and mortality. The risk of major adverse cardiovascular events (MACE) in these patients is unknown.

Objective

To investigate the risk of MACE in patients implanted with cardiac implantable electronic devices (CIEDs) developing AHREs

Methods and results

We included 852 consecutive patients undergoing CIEDs implantation. Primary outcome was a composite endpoint of MACEs occurring after AHREs ≥ 5 min. AHRE was defined as > 175 bpm and lasting ≥ 5 min. We also performed a subgroup analysis in patients with the longest AHRE lasting ≥ 24 h. Cox regression analysis with time-dependent covariates was used to investigate the relationship between AHREs and MACEs.

Mean age was 70.0 ± 13.6 years, and 39.3% were women: 325 patients developed AHREs ≥ 5 min [incidence rate (IR) 13.1% year 95% confidence interval (CI) 11.7–14.6] and 124 patients developed AHREs ≥ 24 h (IR 3.7%/year 95% CI 3.1–4.5). During a median follow-up of 37.0 months (IQR 19.0–64.3, 316,132 patient-years), 152 MACEs occurred (IR 4.85%/year, 95% CI 4.11–5.68). The IR of MACE occurring after AHREs onset was higher in patients developing AHREs ≥ 24 h (IR 1.13%/year) than AHREs ≥ 5 min (IR 0.63%/year, p = 0.030).

Multivariable Cox regression analysis showed that AHREs ≥ 5 min (HR 1.788, 95% CI 1.247–2.562, p = 0.002), diabetes (HR 1.909, 95% CI 1.358–2.683, p < 0.001), heart failure (HR 2.203, 95% CI 1.527–3.178, p < 0.001), and coronary artery disease (HR 1.862, 95% CI 1.293–2.681, p = 0.001) were associated to MACE. This association was even stronger for AHREs ≥ 24 h (HR 2.390, 95% CI 1.481–3.857, p < 0.001).

Conclusions

Patients implanted with CIEDs developing AHREs show a significant risk for MACE, which is dependent on AHREs burden. Cardiovascular prevention strategies in this patient population are warranted.

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Authors and Affiliations

  1. Institute of Applied Health Research, University of Birmingham, Birmingham, UK

    Daniele Pastori, Kazuo Miyazawa, Yanguang Li, Orsolya Székely, Farhan Shahid & Gregory Y. H. Lip

  2. Department of Internal Medicine and Medical Specialties, I Clinica Medica, Atherothrombosis Center, Sapienza University of Rome, Rome, Italy

    Daniele Pastori

  3. Department of Cardiology, Chinese PLA Medical School, Chinese PLA General Hospital, Beijing, China

    Yanguang Li

  4. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

    Alessio Farcomeni

  5. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK

    Gregory Y. H. Lip

  6. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Gregory Y. H. Lip

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  1. Daniele Pastori
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  2. Kazuo Miyazawa
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  3. Yanguang Li
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  7. Gregory Y. H. Lip
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Correspondence to Gregory Y. H. Lip.

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Pastori, D., Miyazawa, K., Li, Y. et al. Atrial high-rate episodes and risk of major adverse cardiovascular events in patients with cardiac implantable electronic devices. Clin Res Cardiol 109, 96–102 (2020). https://doi.org/10.1007/s00392-019-01493-z

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  • DOI: https://doi.org/10.1007/s00392-019-01493-z

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