Department of Medicine, Jefferson Einstein Hospital, Philadelphia, Pennsylvania, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Pacing Clin Electrophysiol. 2024 Nov;47(11):1548-1555. doi: 10.1111/pace.15084. Epub 2024 Oct 5.
Atrial high-rate episodes (AHRE) have been linked to increased thromboembolic risk and all-cause mortality in patients with cardiac implantable electronic devices (CIEDs). Various predictors of AHRE development have been identified, emphasizing the need for close monitoring and the potential transition to clinical atrial fibrillation (AF). However, the predictive value of P wave characteristics on AHRE development remains conflicting. This meta-analysis aims to summarize existing data to investigate this association.
We examined studies from MEDLINE and EMBASE databases up to May 2024 to investigate the association of baseline P-wave duration (PWD), P-wave dispersion (PWDIS), and interatrial block (IAB) with the risk of developing AHRE. We extracted the mean and standard deviations of PWD and PWDIS to calculate the pooled mean difference (MD). Risk ratios (RR) and 95% confidence intervals (CIs) were used to assess the association between IAB and AHRE risk, using the generic inverse variance method for combination.
The meta-analysis included nine studies. Patients with AHRE had longer PWD and PWDIS compared to those without AHRE, with a pooled MD for PWD of 9.17 ms (95% CI: 4.74-13.60; I = 47%, p < 0.001) and a pooled MD for PWDIS of 20.56 ms (95% CI: 11.57-29.56; I = 57%, p < 0.001). Additionally, patients with IAB had a higher risk of developing AHRE, with a pooled RR of 3.33 (95% CI: 2.53-4.38; I = 0%, p < 0.001), compared to those without IAB.
Our meta-analysis found that patients with AHRE had higher PWD and PWDIS than those without AHRE. Additionally, IAB was associated with a higher risk of developing AHRE. These findings emphasize the importance of close monitoring and risk stratification, particularly for patients with P wave abnormalities.
房性心动过速（AHRE）与心脏植入式电子设备（CIED）患者的血栓栓塞风险增加和全因死亡率相关。已经确定了各种 AHRE 发展的预测因素，强调需要密切监测，并有可能转变为临床心房颤动（AF）。然而，P 波特征对 AHRE 发展的预测价值仍然存在争议。本荟萃分析旨在总结现有数据以研究这种相关性。
我们检查了截至 2024 年 5 月 MEDLINE 和 EMBASE 数据库中的研究，以调查基础 P 波持续时间（PWD）、P 波离散度（PWDIS）和房间隔阻滞（IAB）与发生 AHRE 风险的关系。我们提取 PWD 和 PWDIS 的平均值和标准差，以计算汇总平均差（MD）。使用通用逆方差法进行组合，使用风险比（RR）和 95%置信区间（CI）来评估 IAB 与 AHRE 风险之间的关系。
荟萃分析纳入了 9 项研究。与无 AHRE 的患者相比，AHRE 患者的 PWD 和 PWDIS 更长，PWD 的汇总 MD 为 9.17ms（95%CI：4.74-13.60；I = 47%，p <0.001），PWDIS 的汇总 MD 为 20.56ms（95%CI：11.57-29.56；I = 57%，p <0.001）。此外，与无 IAB 的患者相比，有 IAB 的患者发生 AHRE 的风险更高，汇总 RR 为 3.33（95%CI：2.53-4.38；I = 0%，p <0.001）。
我们的荟萃分析发现，与无 AHRE 的患者相比，AHRE 患者的 PWD 和 PWDIS 更高。此外，IAB 与发生 AHRE 的风险增加相关。这些发现强调了密切监测和风险分层的重要性，特别是对于 P 波异常的患者。
