State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
Can J Cardiol. 2024 Apr;40(4):598-607. doi: 10.1016/j.cjca.2023.12.007. Epub 2023 Dec 12.
Device-detected atrial high-rate episodes (AHREs) were associated with an increased thromboembolic risk. Although limited data regarding the long-term prognosis of patients with AHRE were controversial, this study aimed to identify the association of device-detected AHRE with mortality.
This observational study included patients with implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) placement and no history of atrial fibrillation (AF), atrial flutter (AFL), or atrial tachycardia (AT). During follow-up, patients with at least 1 day of AHRE duration ≥ 15 minutes were identified. The primary endpoint was cardiovascular mortality, and the secondary endpoint was all-cause mortality.
During a mean follow-up period of 4.2 years, AHREs were detected in 124 of 343 (36.2%) patients. Of these, 44 deaths (35.5%) occurred in 124 patients with AHREs, which was significantly higher than those without AHREs (43 of 219; 19.6%; P = 0.001). The multivariate analysis revealed that patients with AHRE had a significantly higher risk of cardiovascular (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.23-4.67; P = 0.010), and all-cause mortality (HR, 2.31; 95% CI, 1.49-3.59; P < 0.001). Further analysis indicated that this association remained significant in patients with higher burden (≥ 6 hours) but not in patients with lower burden (≥ 15 minutes to 6 hours). Notably, even after excluding the patients diagnosed with clinical AF during follow-up, the remaining patients with AHREs still exhibited a higher risk of cardiovascular and all-cause mortality compared with patients without AHREs.
AHREs were prevalent in ICD or CRT-D recipients with no history of clinical AF, AFL, or AT and were associated with more than twice the risk of cardiovascular and all-cause mortality.
No. ChiCTR-ONRC-13003695.
器械检测到的心房高频事件（AHREs）与血栓栓塞风险增加有关。尽管关于 AHRE 患者长期预后的数据有限，但存在争议，本研究旨在确定器械检测到的 AHRE 与死亡率之间的关系。
本观察性研究纳入了植入式心脏复律除颤器（ICD）或心脏再同步治疗除颤器（CRT-D）植入且无房颤（AF）、心房扑动（AFL）或房性心动过速（AT）病史的患者。在随访期间，确定至少有 1 天 AHRE 持续时间≥15 分钟的患者。主要终点是心血管死亡率，次要终点是全因死亡率。
在平均 4.2 年的随访期间，343 名患者中有 124 名（36.2%）检测到 AHREs。其中，124 名 AHRE 患者中有 44 例死亡（35.5%），明显高于无 AHRE 患者（219 例中的 43 例；19.6%；P=0.001）。多变量分析显示，AHRE 患者发生心血管（风险比 [HR]，2.40；95%置信区间 [CI]，1.23-4.67；P=0.010）和全因死亡率（HR，2.31；95%CI，1.49-3.59；P<0.001）的风险显著增加。进一步分析表明，这种关联在负担较重（≥6 小时）的患者中仍然显著，但在负担较轻（≥15 分钟至 6 小时）的患者中不显著。值得注意的是，即使在排除随访期间诊断为临床 AF 的患者后，仍有 AHRE 的剩余患者与无 AHRE 的患者相比，发生心血管和全因死亡率的风险仍然更高。
AHRE 在无临床 AF、AFL 或 AT 病史的 ICD 或 CRT-D 接受者中较为常见，与心血管和全因死亡率增加超过两倍相关。
No. ChiCTR-ONRC-13003695。
