Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
Department of Heart Rhythm, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
Heart Rhythm. 2024 Dec;21(12):2543-2551. doi: 10.1016/j.hrthm.2024.06.046. Epub 2024 Jun 25.
Heart rate score (HRSc), the percentage of atrial depolarizations in the largest paced and sensed 10-beats/min histogram bin recorded in cardiac devices, is associated with several adverse outcomes, but it remains uncertain whether HRSc independently predicts atrial high-rate episodes (AHREs) in patients with sinus node dysfunction (SND) undergoing pacemaker (PM) implantation.
This study aimed to determine whether initial HRSc after PM implantation predicts new-onset AHREs in patients with SND.
Patients had Boston Scientific PMs implanted for SND from 2012 to 2021 at Cleveland Clinic, University of Occupational and Environmental Health, Japan, Kyushu Rosai Hospital, and JCHO Kyushu Hospital. Patients were excluded if they had atrial fibrillation before PM implantation or AHREs within 3 months after implantation. Subsequent AHREs after implantation were evaluated and correlated with HRSc.
During 48.9 (interquartile range, 25.7-50.4) months, 130 consecutive PM patients (76 ± 10 years; 40% male) had a median initial HRSc of 74% (57%-86%). AHREs defined by >1%, >6 h/d burden, and atrial tachycardia response events >24 hours developed in 27 of 130 (21%), 15 of 130 (12%), and 9 of 130 (7%), respectively. For each definition, patients with HRSc ≥80% had higher occurrence of AHREs than those with HRSc <80% (both P = .008, log-rank test). After adjustment for age, race, comorbidities, left ventricular ejection fraction, left atrial diameter, and cumulative percentage of right atrial and right ventricular pacing, initial HRSc ≥80% (hazard ratio, 3.33; 95% CI, 1.35-8.18; P = .009) and male sex (hazard ratio, 2.59; 95% CI, 1.06-6.33; P = .04) independently predicted AHREs.
HRSc ≥80% is associated with new-onset, device-determined AHREs for patients undergoing PM implantation for SND. HRSc may have prognostic and therapeutic implications.
心率得分（HRSc）是心脏设备记录的最大起搏和感知 10 拍/分钟直方图中心房去极化的百分比，与多种不良结局相关，但尚不确定 HRSc 是否独立预测窦性心动过缓（SND）患者起搏器（PM）植入后发生的心房高频事件（AHREs）。
本研究旨在确定 PM 植入后初始 HRSc 是否可预测 SND 患者新发生的 AHREs。
2012 年至 2021 年，克利夫兰诊所、日本久留米劳灾医院、九州大学医院和 JCHO 九州医院的患者因 SND 植入了波士顿科学 PM。如果患者在 PM 植入前有房颤或植入后 3 个月内有 AHREs，则将其排除在外。植入后对后续 AHREs 进行评估，并与 HRSc 相关联。
在 48.9（四分位距，25.7-50.4）个月期间，130 例连续 PM 患者（76±10 岁；40%为男性）的初始 HRSc 中位数为 74%（57%-86%）。定义为>1%、>6 h/d 负荷和>24 小时心房性心动过速反应事件的 AHREs分别在 27/130（21%）、15/130（12%）和 9/130（7%）的患者中出现。对于每种定义，HRSc≥80%的患者发生 AHREs的几率高于 HRSc<80%的患者（均 P=.008，对数秩检验）。在校正年龄、种族、合并症、左心室射血分数、左心房直径以及右心房和右心室起搏的累计百分比后，初始 HRSc≥80%（风险比，3.33；95%CI，1.35-8.18；P=.009）和男性（风险比，2.59；95%CI，1.06-6.33；P=.04）独立预测 AHREs。
HRSc≥80%与 SND 患者 PM 植入后新发、器械确定的 AHREs 相关。HRSc 可能具有预后和治疗意义。
