Association of atrial high-rate episodes daily burden with the risk of cardiovascular death, heart failure hospitalization, and stroke.
Giovanni Luca Botto, Ennio C L Pisanò, Antonio Rapacciuolo et al.
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In 30 seconds
This analysis of patients with sinus node dysfunction and implanted dual-chamber pacemakers or defibrillators from the multicentre B3 randomized trial assessed whether device-detected atrial high-rate episode (AHRE) burden was associated with cardiovascular outcomes over 3 years. Among patients without prior atrial fibrillation (AF), a daily AHRE burden of at least 6 minutes was associated with the composite of cardiovascular death, worsening heart failure hospitalization, and stroke or transient ischemic attack (hazard ratio 4.9; 95% CI, 2.19-10.91). No significant association was found among patients with prior AF.
Key findings
- AHRE burden ≥6 minutes occurred in 52.5% of patients; 47.1% of those patients had no prior AF.
- Among patients without prior AF, AHRE burden ≥6 minutes was associated with the primary composite outcome (HR 4.9; 95% CI, 2.19-10.91; P < .001).
- In patients without prior AF, associations were reported for cardiovascular death (P = .033), worsening heart failure hospitalization (P < .001), and progression to long-lasting AF (P < .001), but not stroke/TIA (P = .34).
- Among patients with prior AF, the primary outcome was not significantly associated with AHRE burden ≥6 minutes (HR 0.83; 95% CI, 0.37-1.87; P = .65).
Why it matters
Device-detected AHREs may identify patients without a history of AF who have greater risk of major cardiovascular events, particularly heart failure hospitalization and cardiovascular death. The differing findings by prior AF status suggest that AHRE burden should be interpreted in the context of AF history; the results do not establish that AHREs cause these outcomes.
What to keep in mind
The analysis was based on patients with sinus node dysfunction and implanted devices, so its findings may not apply to other populations. The abstract reports 65 primary events, limiting the number of outcome events available for analysis.