Atrial high-rate episodes intensify R₂CHA₂DS₂-VASc score for prognostic stratification in pacemaker patients.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Patients with device-detected atrial high-rate episodes (AHRE) exhibit a heightened risk of major adverse cardiovascular events (MACE).
• Existing risk stratification scores like CHADS2, CHA2DS2-VASc, R2CHADS2, and R2CHA2DS2-VASc have been evaluated for MACE prediction in various patient cohorts.

Purpose of the Study:

• To assess the predictive capability of the R2CHA2DS2-VASc score in conjunction with AHRE ≥ 6 minutes for MACE.
• To evaluate these parameters in patients with dual-chamber pacemakers (PPM) but without a history of atrial fibrillation (AF).

Main Methods:

• Retrospective analysis of 376 patients with dual-chamber PPM and no prior AF history.
• Determination of CHADS2, R2CHADS2, CHA2DS2-VASc, R2CHA2DS2-VASc scores, and AHRE (≥ or < 6 minutes) for all participants.
• Multivariate Cox regression and ROC-AUC analyses were employed to identify independent predictors of MACE and compare score performance.

Main Results:

• The R2CHA2DS2-VASc score (HR 1.485) and AHRE ≥ 6 minutes (HR 2.125) were identified as independent predictors of MACE.
• An optimal R2CHA2DS2-VASc score cutoff of ≥ 5 demonstrated strong discriminatory power (AUC 0.770).
• Combining AHRE ≥ 6 minutes with the four risk scores significantly improved MACE prediction compared to the scores alone.

Conclusions:

• The R2CHA2DS2-VASc score, particularly when incorporating AHRE ≥ 6 minutes, is a valuable tool for MACE risk stratification in PPM patients without prior AF.
• Enhanced risk assessment using these scores is crucial for patients with PPM who experience AHRE ≥ 6 minutes.