Min Kim1, Tae Hoon Kim1, Hee Tae Yu1, Eue Keun Choi2, Hyung Seob Park3, Junbeom Park4, Young Soo Lee5, Ki Woon Kang6, Jaemin Shim7, Jung Hoon Sung8, Il Young Oh9, Boyoung Joung10. 1. Division of Cardiology, Yonsei University Health System, Seoul, Korea. 2. Department of Cardiology, Seoul National University Hospital, Seoul, Korea. 3. Division of Cardiology, Keimyung University Hospital, Daegu, Korea. 4. Department of Cardiology, Ewha Womans University Hospital, Seoul, Korea. 5. Division of Cardiology, Daegu Catholic University Hospital, Daegu, Korea. 6. Division of Cardiology, Eulji University Hospital, Daejeon, Korea. 7. Department of Cardiology, Korea University Hospital, Seoul, Korea. 8. Department of Cardiology, CHA Bundang University Hospital, Seongnam, Korea. 9. Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea. ilyoung.oh@snubh.org. 10. Division of Cardiology, Yonsei University Health System, Seoul, Korea. cby6908@yuhs.ac.
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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03303872.
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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03303872.