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Prognostic values of atrial high-rate episodes on mortality risks in CIED patients

Phuuwadith Wattanachayakul1, Panat Yanpiset2, Narathorn Kulthamrongsri3

  • 1Department of Medicine, Jefferson Einstein Hospital, Philadelphia, PA, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.

Journal of Cardiology
|February 15, 2025
PubMed

Insights

Patients with cardiac implantable electronic devices (CIEDs) experiencing atrial high-rate episodes (AHRE) face increased mortality risks. This includes both all-cause and cardiovascular mortality, highlighting a significant health concern for this population.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Public Health

Background:

  • Recent data indicate patients with cardiac implantable electronic devices (CIEDs) and atrial high-rate episodes (AHRE) have elevated systemic thromboembolism risk, even without prior atrial fibrillation.
  • However, existing research on the impact of AHRE on mortality outcomes in these patients presents conflicting findings.
  • This study addresses this gap by systematically reviewing and meta-analyzing available data.

Purpose of the Study:

  • To investigate the association between atrial high-rate episodes (AHRE) and mortality risk in patients with CIEDs.
  • To clarify the impact of AHRE on both all-cause and cardiovascular mortality.
  • To provide a comprehensive summary of current evidence through systematic review and meta-analysis.

Main Methods:

  • A systematic review of MEDLINE and EMBASE databases was conducted up to May 2024.
  • The review focused on patients with CIEDs who did not have a history of atrial fibrillation at implantation.
  • Data on all-cause and cardiovascular mortality were extracted, and relative risks (RR) or hazard ratios with 95% confidence intervals (CIs) were pooled using the generic inverse variance method.

Main Results:

  • Fifteen cohort studies were included in the meta-analysis.
  • Patients with AHRE demonstrated a significantly higher risk of all-cause mortality (pooled RR: 1.57; 95% CI: 1.21-2.03).
  • AHRE was also associated with a significantly increased risk of cardiovascular mortality (pooled RR: 1.80; 95% CI: 1.06-3.05).

Conclusions:

  • Patients with CIEDs who develop AHRE face a heightened risk of all-cause mortality.
  • These patients also exhibit an increased risk of cardiovascular mortality.
  • The findings underscore the clinical significance of monitoring AHRE in CIED patients.
Abstract

Keywords:
All-cause mortalityAtrial high-rate episodeCardiac implantable electronic devicesCardiovascular mortalityMeta-analysis

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