Doundoulakis Ioannis, Gavriilaki Maria, Tsiachris Dimitris, Arsenos Petros, Antoniou Christos-Konstantinos, Dimou Smaro, Soulaidopoulos Stergios, Farmakis Ioannis, Akrivos Evangelos, Stoiloudis Panagiotis, Notas Konstantinos, Kimiskidis Vasilios K, Giannakoulas George, Paraskevaidis Stylianos, Gatzoulis Konstantinos A, Tsioufis Konstantinos
First Department of Cardiology, University of Athens Medical School, Athens, Greece.
Department of Cardiology, 424 General Military Hospital, Thessaloniki, Greece.
Cardiovasc Drugs Ther. 2022 Oct;36(5):951-958. doi: 10.1007/s10557-021-07209-8. Epub 2021 Jun 5.
Atrial high-rate episodes (AHREs) recorded with cardiac implantable electronic devices (CIEDs) have been associated with the development of clinical atrial fibrillation (AF) and increase in stroke and death risk. We sought to perform a systematic review with a meta-analysis to evaluate the prevalence of AHREs detected by CIEDs, their association with stroke risk, development of clinical AF, and mortality among patients without a documented history of AF.
We searched several databases, ClinicalTrials.gov, references of reviews, and meeting abstract books without any language restrictions up to 9 September 2020. We studied patients with CIEDs in whom AHREs were detected. Exclusion criterion was AF history. Our primary outcome was the risk of ischemic stroke in patients with AHREs.
We deemed eligible eight studies for the meta-analysis enrolling a total of 4322 patients with CIED and without a documented AF history. The overall AHRE incidence ratio was estimated to be 17.56 (95% CI, 8.61 to 35.79) cases per 100 person-years. Evidence of moderate certainty suggests that patients with documented AHREs were 4.45 times (95% CI 2.87-6.91) more likely to develop clinical AF. Evidence of low confidence suggests that AHREs were associated with a 1.90-fold increased stroke risk (95% CI 1.19-3.05). AHREs were not associated with a statistically significant increased mortality risk.
The present systematic review and meta-analysis demonstrated that among patients without a documented history of AF, the detection of AHREs by CIEDs was associated with significant increased risk of clinical AF and stroke.
REGISTRATION NUMBER (DOI): Available in https://doi.org/10.17605/OSF.IO/ZRF6M .
心脏植入式电子设备（CIED）记录的心房高速率发作（AHRE）与临床房颤（AF）的发生以及中风和死亡风险增加有关。我们试图进行一项系统评价和荟萃分析，以评估CIED检测到的AHRE的患病率、其与中风风险、临床AF发生以及无AF记录病史患者死亡率的关联。
我们检索了多个数据库、ClinicalTrials.gov、综述参考文献以及会议摘要书籍，检索截至2020年9月9日，无任何语言限制。我们研究了检测到AHRE的CIED患者。排除标准为有AF病史。我们的主要结局是AHRE患者发生缺血性中风的风险。
我们认为八项研究符合荟萃分析的纳入标准，共纳入4322例有CIED且无AF记录病史的患者。总体AHRE发病率估计为每100人年17.56例（95%CI，8.61至35.79）。中等确定性证据表明，有记录的AHRE患者发生临床AF的可能性高4.45倍（95%CI 2.87 - 6.91）。低置信度证据表明，AHRE与中风风险增加1.90倍相关（95%CI 1.19 - 3.05）。AHRE与死亡率风险增加无统计学显著关联。
本系统评价和荟萃分析表明，在无AF记录病史的患者中，CIED检测到AHRE与临床AF和中风风险显著增加相关。
注册号（DOI）：可在https://doi.org/10.17605/OSF.IO/ZRF6M获取。
