Atrial high-rate episodes and risk of major adverse cardiovascular events in patients with cardiac implantable electronic devices

Background Patients with atrial high-rate episodes (AHREs) are at higher risk of thromboembolic events and mortality. The risk of major adverse cardiovascular events (MACE) in these patients is unknown. Objective To investigate the risk of MACE in patients implanted with cardiac implantable electronic devices (CIEDs) developing AHREs Methods and results We included 852 consecutive patients undergoing CIEDs implantation. Primary outcome was a composite endpoint of MACEs occurring after AHREs ≥ 5 min. AHRE was defined as > 175 bpm and lasting ≥ 5 min. We also performed a subgroup analysis in patients with the longest AHRE lasting ≥ 24 h. Cox regression analysis with time-dependent covariates was used to investigate the relationship between AHREs and MACEs. Mean age was 70.0 ± 13.6 years, and 39.3% were women: 325 patients developed AHREs ≥ 5 min [incidence rate (IR) 13.1% year 95% confidence interval (CI) 11.7–14.6] and 124 patients developed AHREs ≥ 24 h (IR 3.7%/year 95% CI 3.1–4.5). During a median follow-up of 37.0 months (IQR 19.0–64.3, 316,132 patient-years), 152 MACEs occurred (IR 4.85%/year, 95% CI 4.11–5.68). The IR of MACE occurring after AHREs onset was higher in patients developing AHREs ≥ 24 h (IR 1.13%/year) than AHREs ≥ 5 min (IR 0.63%/year, p = 0.030). Multivariable Cox regression analysis showed that AHREs ≥ 5 min (HR 1.788, 95% CI 1.247–2.562, p = 0.002), diabetes (HR 1.909, 95% CI 1.358–2.683, p < 0.001), heart failure (HR 2.203, 95% CI 1.527–3.178, p < 0.001), and coronary artery disease (HR 1.862, 95% CI 1.293–2.681, p = 0.001) were associated to MACE. This association was even stronger for AHREs ≥ 24 h (HR 2.390, 95% CI 1.481–3.857, p < 0.001). Conclusions Patients implanted with CIEDs developing AHREs show a significant risk for MACE, which is dependent on AHREs burden. Cardiovascular prevention strategies in this patient population are warranted.events (MACE) in these patients is unknown.