Meng Yanhai, Zhang Yanbo, Zhu Changsheng, Nie Changrong, Liu Ping, Chang Shuo, Wang Shuiyun
Surgical Intensive Care Unit, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Surgical Intensive Care Unit, Fuwai Yunnan Cardiovascular Hospital, Kunming, China.
Surgical Intensive Care Unit, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Cardiol. 2023 Jan 15;371:211-220. doi: 10.1016/j.ijcard.2022.09.046. Epub 2022 Oct 13.
Atrial high-rate episode (AHRE) and stroke are related; however, the magnitude of the correlations between different AHRE burdens and stroke remains unknown. We analysed studies that evaluated this relationship.
We searched for observational controlled studies that reported the associations of different AHRE burdens with stroke in populations with cardiac implantable electronic devices (CIEDs). The primary endpoint was stroke or thrombosis during follow-up. We performed subgroup analyses according to the classification criteria and research design of the included studies.
Of the 5985 studies identified, 9 met the eligibility criteria and included 42,958 patients. Patients with low and high AHRE burdens had a 1.2-fold risk of stroke (no heterogeneity) and a 2.52-fold risk of stroke (moderate heterogeneity), respectively. After excluding studies analysing the atrial fibrillation history, no significant difference in progressive stroke risk was observed for patients with a low AHRE burden (without significant heterogeneity). An increased likelihood of stroke was observed for patients with a high AHRE burden (decreased heterogeneity). Four of the nine studies classified high and low AHRE burdens using the longest AHRE time. Five studies classified high and low AHRE burdens based on the median of the total AHRE time as the cutoff value. Low and high AHRE burdens were more closely related to stroke when classified by the total AHRE duration than when classified by the single longest AHRE duration.
For populations with CIEDs without an atrial fibrillation history, a high AHRE burden was significantly associated with stroke.
心房高频率发作（AHRE）与中风相关；然而，不同AHRE负荷与中风之间的关联程度仍不清楚。我们分析了评估这种关系的研究。
我们检索了观察性对照研究，这些研究报告了心脏植入式电子设备（CIED）人群中不同AHRE负荷与中风的关联。主要终点是随访期间的中风或血栓形成。我们根据纳入研究的分类标准和研究设计进行了亚组分析。
在识别出的5985项研究中，9项符合纳入标准，共纳入42958例患者。AHRE负荷低和高的患者中风风险分别为1.2倍（无异质性）和2.52倍（中度异质性）。排除分析房颤病史的研究后，AHRE负荷低的患者进展性中风风险无显著差异（无异质性）。AHRE负荷高的患者中风可能性增加（异质性降低）。9项研究中有4项使用最长AHRE时间对高和低AHRE负荷进行分类。5项研究以总AHRE时间的中位数为临界值对高和低AHRE负荷进行分类。与按单个最长AHRE持续时间分类相比，按总AHRE持续时间分类时，低和高AHRE负荷与中风的关系更密切。
对于无房颤病史的CIED人群，高AHRE负荷与中风显著相关。
