Burden of Implanted-Device-Detected Atrial High-Rate Episode Is Associated With Future Heart Failure Events　― Clinical Significance of Asymptomatic Atrial Fibrillation in Patients With Implantable Cardiac Electronic Devices ―

Abstract

for the diagnosis of brief episodes of arrhythmia, including paroxysmal AF, which are recorded as atrial high-rate episodes (AHREs), particularly in patients without ECGdocumented AF. 6 Using this technique, new-onset atrial tachyarrhythmia (AT)/AF can be diagnosed earlier in patients with CIEDs than in patients without CIEDs. AHREs detected using CIEDs are reportedly associated with an increased risk of stroke and systemic embolism, even in patients without any evidence of AF. 7 Furthermore, AHREs lasting longer (>5.5 h during a 30-day period) are associated with a double risk of embolic events. 8,9 Although Healey et al reported no association between subclinical AF and hospitalization for HF, 9 more recent studies have indicated that AHREs detected using CIEDs are associated with an increased risk of worsening HF. 10,11 Therefore, the correlation between AHREs detected using CIEDs and A trial fibrillation (AF) is a common cardiac tachyarrhythmia that is associated with an increased risk of stroke, heart failure (HF), and death. The presence of AF is reportedly associated with an increased risk of HF, regardless of its clinical pattern. 1,2 Changes in clinical AF (i.e., progression to permanent/persistent AF from paroxysmal AF, prolongation of AF duration, and/or increase in the left atrial size, etc.) are clinical predictors of HF. 1-5 However, clinically detecting AF in the early phase is not always easy, particularly in cases of asymptomatic AF. Although repeat ECG recording or 24-h ambulatory ECG monitoring are considered useful in detecting AF in the early phase, their sensitivities as detection tools are totally limited. 4 Continuous rhythm monitoring using cardiac implantable electronic devices (CIEDs) has recently been attempted

Relationship between device‐detected subclinical atrial fibrillation and heart failure in patients with cardiac resynchronization therapy defibrillator

“…15 Atrial systole constitutes a considerable proportion of the cardiac output in patients predisposed to HF, and its loss during episodes of S-AF might also account for some of the observed increase in HF risk. 16 Nishinarita 17 there was no relationship between AF and mortality in our study.…”

“…Nishinarita 17 et al reported that in patients without clinical AF who had a cardiac device, new‐onset atrial high‐rate episode identified as asymptomatic AF was detected in 32.7% of the patients during the first year after implantation of the cardiac device. Furthermore, a higher atrial high‐rate episode burden was more strongly associated with future risk of worsening HF in patients with a cardiac device.…”

“…15 Atrial systole constitutes a considerable proportion of the cardiac output in patients predisposed to HF, and its loss during episodes of S-AF might also account for some of the observed increase in HF risk. 16 Nishinarita 17 et al reported that in patients without clinical AF who had a cardiac device, new-onset atrial high-rate episode identified as asymptomatic AF was detected in 32.7% of the patients during the first year after implantation of the cardiac device. Furthermore, a higher atrial high-rate episode burden was more strongly associated with future risk of worsening HF in patients with a cardiac device.…”

Atrial high-rate episodes predict major adverse cardio/cerebrovascular events in patients with cardiac implantable electrical devices

“…New-onset higher AHRE burden was also associated with subsequent risk for heart failure in patients with CIEDs 7 . The occurrence of AHRE is suggested to be a marker of increased risk of ventricular tachyarrhythmias and poor prognosis 8 .…”

Novel Predictor for New-Onset Atrial High-Rate Episode in Patients With a Dual-Chamber Pacemaker

“…However, because AHRE has been reported to be associated with increased risks of stroke, systemic embolism, and worsening heart failure, the prediction of new-onset AHRE through PWD evaluation should be useful in managing patients with CIED. 2,5,27…”