Inflammation and the risk of atrial high-rate episodes (AHREs) in patients with cardiac implantable electronic devices

Abstract

IntroductionAtrial high-rate episodes (AHREs) are associated with an increased risk of developing atrial fibrillation and thromboembolism. The characteristics of ‘real world’ patients developing AHREs are poorly known.MethodsWe included 496 consecutive patients with cardiac implantable electronic devices (CIEDs). Primary endpoint was occurrence of AHREs, defined as > 175 bpm and lasting > 5 min, in a median follow-up of 16.5 (IQR 3.9–38.6) months (1082.4 patient-years). We also tested the predictive value of clinical risk scores for AHREs.ResultsMean age was 68.8 ± 14.0 years, and 35.5% were women; AHREs were recorded in 173 patients [34.7%, 16.0%/year, 95% confidence interval (CI) 13.7–18.6]. Multivariable Cox regression analysis showed that age [hazard ratio (HR) 1.020, 95% CI 1.004–1.035, p = 0.011], prior AF (HR 3.521, 95% CI 2.831–5.206, p < 0.001), white cell count (HR 1.039, 95% CI 1.007–1.072, p = 0.016) and high C reactive protein (CRP; HR 1.039, 95% CI 1.021–2.056, p = 0.038) were independently associated with AHREs. ROC curve analysis showed that the APPLE score (C statistic 0.53, 95% CI 0.48–0.59; p = 0.296) ALARMEc score (C statistic 0.51, 95% CI 0.44–0.57; p = 0.810) were non-significantly associated with AHRE. Similar results were obtained for CHADS2 and CHA2DS2VASc scoreConclusionAHREs are common in CIEDs patients, with age, prior AF, inflammatory markers (high CRP, white cell count) being factors associated with AHREs onset. Clinical risk scores showed limited value for AHREs prediction in this cohort.Electronic supplementary materialThe online version of this article (10.1007/s00392-018-1244-0) contains supplementary material, which is available to authorized users.

Prevalence of atrial high‐rate episodes and the risk factors in Indian patients with cardiac implantable electronic devices: Real‐world data

“…Additionally, in concurrence with the real‐world data that showed a limited value of clinical risk scores in predicting AHREs, the CHA 2 DS 2 VASc score in our analysis also did not show significant association with AHRE occurrence.…”

“…The prevalence of device‐detected AHRE in our study was defined as AHRE with the atrial rate of ≥180 beats/min and lasting ≥5 minutes. There are varying reports for the incidence of AHREs, ranging from 10% to 70%, owing to the different definitions used and time of follow‐up . One report identified AHRE of >5 minutes as an independent predictor for silent ischemic brain lesions, while other studies defined AHRE as episodes with atrial rate >180 beats/min and/or of ≥5 minutes duration within 6 months of pacemaker implantation .…”

“…One report identified AHRE of >5 minutes as an independent predictor for silent ischemic brain lesions, while other studies defined AHRE as episodes with atrial rate >180 beats/min and/or of ≥5 minutes duration within 6 months of pacemaker implantation . A recent “real‐world” study reported AHREs as episodes with >175 beats/min and lasting >5 minutes in 35% of patients with CIEDs with a median follow‐up of 16 months . A retrospective report from patients without documented AF, pacemaker‐detected AHREs of ≥5 minutes was reported in 29% .…”

“…While traditional methods like electrocardiogram (ECG) and Holter monitoring may not assist the detection of silent AHREs, wearable ECG monitoring and novel technologies using smartphone have been shown to aid detection of tachyarrhythmias . Moreover, cardiac implantable electronic devices (CIEDs), such as pacemakers, implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT), and loop recorders, offer early detection of atrial and ventricular arrhythmic episodes even in patients who are asymptomatic . Patients with CIEDs are already predisposed to multiple comorbidities for developing AF and continuous monitoring may help in detecting silent AF episodes in such patients.…”

“…5 Moreover, cardiac implantable electronic devices (CIEDs), such as pacemakers, implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT), and loop recorders, offer early detection of atrial and ventricular arrhythmic episodes even in patients who are asymptomatic. 6 Patients with CIEDs are already predisposed to multiple comorbidities for developing AF and continuous monitoring may help in detecting silent AF episodes in such patients. In patients with implantable devices and with no history of AF, devicedetected AHREs can predict long-term mortality outcomes and are known to be associated with increased risk of clinical AF, stroke, and thromboembolism.…”