Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan.
Sci Rep. 2021 Sep 23;11(1):18992. doi: 10.1038/s41598-021-98258-4.
Patients with atrial high-rate episodes (AHRE) have a high risk of neurologic events, although the causal role and optimal cutoff threshold of AHRE for major adverse cardio/cerebrovascular events (MACCE) are unknown. This study aimed to identify independent factors for AHRE and subsequent atrial fibrillation (AF) after documented AHRE. We enrolled 470 consecutive patients undergoing cardiac implantable electrical device (CIED) implantations. The primary endpoint was subsequent MACCE after AHRE ≥ 6 min, 6 h, and 24 h. AHRE was defined as > 175 beats per minute (bpm) (Medtronic®) or > 200 bpm (Biotronik®) lasting ≥ 30 s. Multivariate Cox regression analysis with time-dependent covariates was used to determine variables associated with independent risk of MACCE. The patients' median age was 76 year, and 126 patients (26.8%) developed AHRE ≥ 6 min, 63 (13.4%) ≥ 6 h, and 39 (8.3%) ≥ 24 h. During follow-up (median: 29 months), 142 MACCE occurred in 123 patients. Optimal AHRE cutoff value was 6 min, with highest Youden index for MACCE. AHRE ≥ 6 min ~ 24 h was independently associated with MACCE and predicted subsequent AF. Male gender, lower body mass index, or BMI, and left atrial diameter were independently associated with AHRE ≥ 6 min ~ 24 h. Patients with CIEDs who develop AHRE ≥ 6 min have an independently increased risk of MACCE. Comprehensive assessment of patients with CIEDs is warranted.
患有心房高频事件（AHRE）的患者有发生神经事件的高风险，尽管 AHRE 与主要不良心脑血管事件（MACCE）之间的因果关系和最佳截断阈值尚不清楚。本研究旨在确定 AHRE 及随后发生的有记录的 AHRE 后心房颤动（AF）的独立因素。我们纳入了 470 例连续接受心脏植入式电子设备（CIED）植入的患者。主要终点是 AHRE≥6 分钟、6 小时和 24 小时后发生的后续 MACCE。AHRE 定义为>175 次/分钟（美敦力®）或>200 次/分钟（百多力®）持续≥30 秒。使用具有时间依赖性协变量的多变量 Cox 回归分析来确定与 MACCE 独立风险相关的变量。患者的中位年龄为 76 岁，126 例（26.8%）发生 AHRE≥6 分钟，63 例（13.4%）≥6 小时，39 例（8.3%）≥24 小时。在随访期间（中位：29 个月），123 例患者中有 142 例发生 MACCE。AHRE≥6 分钟的最佳截断值为 6 分钟，对 MACCE 的 Youden 指数最高。AHRE≥6 分钟24 小时与 MACCE 独立相关，并预测随后发生的 AF。男性、较低的体重指数或 BMI 以及左心房直径与 AHRE≥6 分钟24 小时独立相关。患有 CIED 并发生 AHRE≥6 分钟的患者发生 MACCE 的风险独立增加。有必要对患有 CIED 的患者进行全面评估。
