TY - JOUR
T1 - Early detection of atrial high rate episodes predicts atrial fibrillation and thromboembolic events in patients with cardiac resynchronization therapy
AU - Witt, Christoffer Tobias
AU - Kronborg, Mads Brix
AU - Nohr, Ellen Aagaard
AU - Mortensen, Peter Thomas
AU - Gerdes, Christian
AU - Nielsen, Jens Cosedis
N1 - Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
PY - 2015/12
Y1 - 2015/12
N2 - Background In patients without any history of atrial fibrillation (AF), detection of subclinical atrial high rate episodes (AHRE) by implanted devices has been associated with an increased thromboembolic risk. The predictive value of AHREs in patients with cardiac resynchronization therapy (CRT) is uncertain. Objective We aimed to investigate the prognostic value of early detected AHRE in patients with CRT. Methods This observational study included patients who received CRT and no history of AF. Patients had standard indication for CRT treatment. They were screened for early detected AHREs longer than 6 minutes occurring before 6-month follow-up, and the longest duration of AHREs was recorded. Information on clinical AF and thromboembolic events was obtained from the Danish National Patient Registry. The Cox regression model was used to compute hazard ratios (HRs) with 95% confidence intervals (CIs). Results Of 394 eligible patients, 79 patients (20%) had early AHRE detected. During a median follow-up of 4.6 years, patients with early detected AHREs had an increased risk of clinical AF (HR 2.35; 95% CI 1.47-3.74; P <.001) and thromboembolic events (HR 2.30; 95% CI 1.09-4.83; P =.028). For patients with AHREs longer than 24 hours, these associations were stronger. The risk of mortality was not higher with early detected AHREs (HR 0.97; 95% CI 0.64-1.45; P =.87). Of the 27 patients with thromboembolic events, only 10 patients (37%) had AHREs detected within a 2-month period before the thromboembolic event. Conclusion In patients without any history of AF, detection of early AHREs after CRT implantation is associated with a significantly increased risk of clinical AF and thromboembolic events, particularly AHRE longer than 24 hours.
AB - Background In patients without any history of atrial fibrillation (AF), detection of subclinical atrial high rate episodes (AHRE) by implanted devices has been associated with an increased thromboembolic risk. The predictive value of AHREs in patients with cardiac resynchronization therapy (CRT) is uncertain. Objective We aimed to investigate the prognostic value of early detected AHRE in patients with CRT. Methods This observational study included patients who received CRT and no history of AF. Patients had standard indication for CRT treatment. They were screened for early detected AHREs longer than 6 minutes occurring before 6-month follow-up, and the longest duration of AHREs was recorded. Information on clinical AF and thromboembolic events was obtained from the Danish National Patient Registry. The Cox regression model was used to compute hazard ratios (HRs) with 95% confidence intervals (CIs). Results Of 394 eligible patients, 79 patients (20%) had early AHRE detected. During a median follow-up of 4.6 years, patients with early detected AHREs had an increased risk of clinical AF (HR 2.35; 95% CI 1.47-3.74; P <.001) and thromboembolic events (HR 2.30; 95% CI 1.09-4.83; P =.028). For patients with AHREs longer than 24 hours, these associations were stronger. The risk of mortality was not higher with early detected AHREs (HR 0.97; 95% CI 0.64-1.45; P =.87). Of the 27 patients with thromboembolic events, only 10 patients (37%) had AHREs detected within a 2-month period before the thromboembolic event. Conclusion In patients without any history of AF, detection of early AHREs after CRT implantation is associated with a significantly increased risk of clinical AF and thromboembolic events, particularly AHRE longer than 24 hours.
KW - Atrial fibrillation
KW - Atrial high rate episodes
KW - Cardiac resynchronization therapy
KW - Mortality
KW - Thromboembolic event
KW - Predictive Value of Tests
KW - Risk Assessment
KW - Humans
KW - Middle Aged
KW - Proportional Hazards Models
KW - Male
KW - Time Factors
KW - Defibrillators, Implantable
KW - Female
KW - Thromboembolism/diagnosis
KW - Aged
KW - Atrial Fibrillation/diagnosis
KW - Cardiac Resynchronization Therapy Devices
KW - Cardiac Resynchronization Therapy
KW - Early Diagnosis
KW - Cohort Studies
U2 - 10.1016/j.hrthm.2015.07.007
DO - 10.1016/j.hrthm.2015.07.007
M3 - Journal article
C2 - 26164377
VL - 12
SP - 2368
EP - 2375
JO - Heart Rhythm
JF - Heart Rhythm
SN - 1547-5271
IS - 12
ER -