Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA.
Department of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyushu, Japan.
Europace. 2023 Aug 2;25(9). doi: 10.1093/europace/euad242.
Heart rate score (HRSc), the per cent of atrial paced and sensed event in the largest 10 b.p.m. rate histogram bin of a pacemaker, predicts survival in patients with cardiac devices. No correlation between HRSc and development of atrial fibrillation (AF) has been reported. In this study, we evaluated the relationship between pacemaker post-implantation HRSc and the incidence of newly developed atrial tachyarrhythmias (ATAs).
Patients with dual-chamber pacemakers, implanted 2013-17, with the LATITUDE remote monitoring data with ≥600 000 beats of histogram data collected at baseline were included (N = 34 543). Heart rate score was determined from the initial 3-month post-implantation histogram data. Patients were excluded if they had ATAs, defined as atrial high-rate episodes >5 min or >1% of right atrial beats >170 b.p.m. during the initial 3 months post-implantation. New ATAs, after the baseline period, were defined by each of the following: >1, >10, or >25% of atrial beats >170 b.p.m. or atrial tachycardia response (ATR) events >24 h. Patients were followed a median of 2.8 (1.0-4.0) years. The incidence of ATAs increased in proportion to HRSc (log-rank P-value <0.001), and the initial HRSc ≥70% was associated with increased ATAs by all definitions. Patients with initial HRSc ≥70% were older, had a higher percentage of right atrium pacing (%RA pacing), had a lower percentage of right ventricular pacing (%RV pacing), and were more likely programmed with rate-response vs. subjects with HRSc <70%. Initial HRSc (hazard ratio: 1.07, 95% confidence interval: 1.05-1.09; P < 0.0001) independently predicted ATAs after adjusting for age, gender, %RV pacing, and rate-response programming. The %RA pacing and initial HRSc were correlated.
Heart rate score independently predicts any subsequent duration of ATAs in pacemaker patients.
心率得分（HRSc）是起搏器中最大 10 bpm 速率直方图 bin 中感知到的心房起搏和感知事件的百分比，可预测心脏设备患者的生存率。尚未报道 HRSc 与心房颤动（AF）发展之间存在相关性。在这项研究中，我们评估了起搏器植入后 HRSc 与新发性房性心动过速（ATAs）发生率之间的关系。
纳入 2013-17 年植入双腔起搏器、具有 LATITUDE 远程监测数据且在基线时收集了≥600000 个 beats 直方图数据的患者（N=34543）。HRSc 是从初始植入后 3 个月的直方图数据中确定的。如果患者在初始植入后 3 个月内出现 ATAs（定义为心房高心率发作>5 分钟或>右心房 beats 的 1%>170 bpm），则排除患者。在基线期后，将新的 ATAs 定义为每个以下定义的>1、>10 或>25%的心房 beats >170 bpm 或心房心动过速反应（ATR）事件>24 h。患者中位随访时间为 2.8（1.0-4.0）年。ATAs 的发生率与 HRSc 呈比例增加（对数秩 P 值<0.001），初始 HRSc ≥70%与所有定义的 ATAs 增加相关。初始 HRSc ≥70%的患者年龄较大，右心房起搏百分比（%RA 起搏）较高，右心室起搏百分比（%RV 起搏）较低，与 HRSc<70%的患者相比，更有可能程控为频率反应。初始 HRSc（风险比：1.07，95%置信区间：1.05-1.09；P<0.0001）在调整年龄、性别、%RV 起搏和频率反应程控后，独立预测 ATAs。%RA 起搏和初始 HRSc 呈正相关。
HRSc 独立预测起搏器患者任何随后的 ATAs 持续时间。
