Early detection of atrial high rate episodes predicts atrial fibrillation and thromboembolic events in patients with cardiac resynchronization therapy

Christoffer Tobias Witt, Mads Brix Kronborg, Ellen Aagaard Nohr, Peter Thomas Mortensen, Christian Gerdes, Jens Cosedis Nielsen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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 AHRE 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 AHRE longer than 6 minutes occurring before 6-month follow-up, and the longest duration of AHRE 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 AHRE 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 AHRE longer than 24 hours, these associations were stronger. The risk of mortality was not higher with early AHRE (HR 0.97; 95% CI 0.64-1.45; P = .87). Of the 27 patients with thromboembolic events, only 10 patients (37%) had AHRE detected within 2 months before.

CONCLUSION: In patients without any history of AF, detection of early AHRE after CRT implantation is associated with a significantly increased risk of clinical AF and thromboembolic events, particularly AHRE longer than 24 hours.

OriginalsprogEngelsk
TidsskriftHeart rhythm : the official journal of the Heart Rhythm Society
Vol/bind12
Udgave nummer12
Sider (fra-til)2368–2375
ISSN1547-5271
DOI
StatusUdgivet - 8. jul. 2015

Fingeraftryk

Cardiac Resynchronization Therapy
Confidence Intervals
Proportional Hazards Models
Registries

Citer dette

Witt, Christoffer Tobias ; Kronborg, Mads Brix ; Nohr, Ellen Aagaard ; Mortensen, Peter Thomas ; Gerdes, Christian ; Nielsen, Jens Cosedis. / Early detection of atrial high rate episodes predicts atrial fibrillation and thromboembolic events in patients with cardiac resynchronization therapy. I: Heart rhythm : the official journal of the Heart Rhythm Society. 2015 ; Bind 12, Nr. 12. s. 2368–2375.
@article{779b17ff8123498f967dcd95cf78f7ff,
title = "Early detection of atrial high rate episodes predicts atrial fibrillation and thromboembolic events in patients with cardiac resynchronization therapy",
abstract = "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 AHRE 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 AHRE longer than 6 minutes occurring before 6-month follow-up, and the longest duration of AHRE 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 AHRE 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 AHRE longer than 24 hours, these associations were stronger. The risk of mortality was not higher with early AHRE (HR 0.97; 95{\%} CI 0.64-1.45; P = .87). Of the 27 patients with thromboembolic events, only 10 patients (37{\%}) had AHRE detected within 2 months before.CONCLUSION: In patients without any history of AF, detection of early AHRE after CRT implantation is associated with a significantly increased risk of clinical AF and thromboembolic events, particularly AHRE longer than 24 hours.",
author = "Witt, {Christoffer Tobias} and Kronborg, {Mads Brix} and Nohr, {Ellen Aagaard} and Mortensen, {Peter Thomas} and Christian Gerdes and Nielsen, {Jens Cosedis}",
note = "Copyright {\circledC} 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.",
year = "2015",
month = "7",
day = "8",
doi = "10.1016/j.hrthm.2015.07.007",
language = "English",
volume = "12",
pages = "2368–2375",
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Early detection of atrial high rate episodes predicts atrial fibrillation and thromboembolic events in patients with cardiac resynchronization therapy. / Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard; Mortensen, Peter Thomas; Gerdes, Christian; Nielsen, Jens Cosedis.

I: Heart rhythm : the official journal of the Heart Rhythm Society, Bind 12, Nr. 12, 08.07.2015, s. 2368–2375.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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 - 2015/7/8

Y1 - 2015/7/8

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 AHRE 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 AHRE longer than 6 minutes occurring before 6-month follow-up, and the longest duration of AHRE 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 AHRE 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 AHRE longer than 24 hours, these associations were stronger. The risk of mortality was not higher with early AHRE (HR 0.97; 95% CI 0.64-1.45; P = .87). Of the 27 patients with thromboembolic events, only 10 patients (37%) had AHRE detected within 2 months before.CONCLUSION: In patients without any history of AF, detection of early AHRE 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 AHRE 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 AHRE longer than 6 minutes occurring before 6-month follow-up, and the longest duration of AHRE 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 AHRE 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 AHRE longer than 24 hours, these associations were stronger. The risk of mortality was not higher with early AHRE (HR 0.97; 95% CI 0.64-1.45; P = .87). Of the 27 patients with thromboembolic events, only 10 patients (37%) had AHRE detected within 2 months before.CONCLUSION: In patients without any history of AF, detection of early AHRE after CRT implantation is associated with a significantly increased risk of clinical AF and thromboembolic events, particularly AHRE longer than 24 hours.

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 -