Christoffer Tobias Witt

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

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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.

Original languageEnglish
JournalHeart Rhythm
Publication statusPublished - 8 Jul 2015

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