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HATCH Score and Left Atrial Size Predict Atrial High-Rate Episodes in Patients With Cardiac Implantable Electronic
Ju-Yi Chen1, Tse-Wei Chen1, Wei-Da Lu1
1Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Insights
Patients with cardiac implantable electronic devices experiencing atrial high-rate episodes (AHRE) lasting at least 3 minutes face a higher risk of major adverse cardio/cerebrovascular events (MACCE). A HATCH score and left atrial diameter can help predict AHRE occurrence.
Area of Science:
- Cardiology
- Biomedical Engineering
- Clinical Research
Background:
- Sustained atrial high-rate episodes (AHRE) in patients with cardiac implantable electronic devices (CIEDs) are linked to increased major adverse cardio/cerebrovascular events (MACCE).
- Predictive models and risk factors for AHRE occurrence remain largely unknown.
Purpose of the Study:
- To identify independent risk factors for MACCE in patients with CIEDs.
- To develop and validate risk models for predicting MACCE and AHRE occurrence.
Main Methods:
- Retrospective analysis of 314 patients with CIEDs.
- Definition of AHRE: >175 bpm lasting ≥30 seconds.
- Multivariate Cox and logistic regression with time-dependent covariates to assess MACCE and AHRE risk.
Main Results:
- AHRE ≥3 minutes occurred in 39.8% of patients; 17.5% experienced AHRE ≥6 hours.
- AHRE ≥3 minutes was independently associated with MACCE (AUC=0.716).
- HATCH score (cutoff=3) and left atrial diameter (cutoff=4 cm) independently predicted AHRE ≥3 minutes.
Conclusions:
- AHRE of ≥3 minutes duration in CIED patients independently predicts increased MACCE risk.
- Comprehensive assessment including HATCH score and echocardiography is recommended for risk stratification.
Abstract:
Background: Patients with sustained atrial high-rate episodes (AHRE) have a high risk of major adverse cardio/cerebrovascular events (MACCE). However, the prediction model and factors for the occurrence of AHRE are unknown. We aimed to identify independent factors and various risk models for predicting MACCE and AHRE. Methods: We retrospectively enrolled 314 consecutive patients who had cardiac implantable electronic devices (CIEDs). The primary endpoint was MACCE after AHRE ≥3, 6 min, and 6 h. Atrial high-rate episodes was defined as >175 bpm (Medtronic®) lasting ≥30 s. Multivariate Cox and logistic regression analysis with time-dependent covariates were used to determine variables associated with independent risk of MACCE and occurrence of AHRE ≥3 min, respectively. Results: One hundred twenty-five patients (39.8%) developed AHRE ≥3 min, 103 (32.8%) ≥6 min, and 55 (17.5%) ≥6 h. During follow-up (median 32 months), 77 MACCE occurred (incidence 9.20/100 patient years, 95% CI 5.66-18.39). The optimal AHRE cutoff value was 3 min for MACCE, with highest Youden index 1.350 (AUC, 0.716; 95% CI, 0.638-0.793; p < 0.001). Atrial high-rate episodes ≥3 min-6 h were independently associated with MACCE. HATCH score and left atrial diameter were independently associated with AHRE ≥3 min. The optimal cutoff for HATCH score was 3 and for left atrial diameter was 4 cm for AHRE ≥3 min. Conclusion: Patients with CIEDs who develop AHRE ≥3 min have an independently increased risk of MACCE. Comprehensive assessment using HATCH score and echocardiography of patients with CIEDs is warranted.
