Patients with implantable cardiac devices developing atrial high-rate episodes at increased risk of cardiavascular events

  • Pastori D & al.
  • Clin Res Cardiol
  • 29 May 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Patients implanted with cardiac implantable electronic devices (CIEDs) developing atrial high-rate episodes (AHREs) show a significant risk for major adverse cardiovascular events (MACEs).
  • Risk is dependent on AHREs burden.

Why this matters

  • Findings suggest that cardiovascular prevention strategies in patients with implantable cardiac devices developing AHREs are warranted.

Study design

  • 856 patients who underwent CIED implantation were included.
  • Primary outcome: occurrence of MACEs (acute heart failure, myocardial infarction/cardiac revascularisation, cardiovascular death, cardiovascular hospitalisation and ventricular tachycardia/ventricular fibrillation) after AHREs ≥5 minutes and ≥24 hours.
  • AHRE was defined as >175 beats per minute and lasting ≥5 minutes.
  • Funding: None disclosed.

Key results

  • During follow-up, 325 patients developed AHREs ≥5 minutes (incidence rate [IR], 13.1% per year; 95% CI, 11.7-14.6%) and 124 patients developed AHREs ≥24 hours (IR, 3.7% per year; 95% CI, 3.1-4.5%).
  • During a median follow-up of 37.0 months (interquartile range [IQR], 19.0-64.3 months; 3161.32 patient-years), 152 MACEs were reported (IR, 4.85% per year; 95% CI, 4.11-5.68%).
  • IR of MACE after AHREs onset was higher in patients developing AHREs ≥24 hours (IR, 1.13% per year) vs those developing ≥5 minutes (IR, 0.63% per year; P=.030).
  • In multivariable Cox regression analysis, AHREs ≥5 minutes (HR, 1.788; 95% CI, 1.247-2.562; P=.002), diabetes (HR, 1.909; 95% CI, 1.358-2.683) and heart failure (HR, 2.203; 95% CI, 1.527-3.178; P<.001 for both and coronary artery disease ci p=".001)" were associated with mace.>
  • This association was stronger for AHREs ≥24 hours (HR, 2.390; 95% CI, 1.481-3.857; P<.001>

Limitations

  • Single-centre study.
  • Observational design could determine causality.