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Echocardiographic Parameters of Atrial High-rate Episodes in Patients with Cardiac Implantable Electronic Devices

Ahmed Nabil Ali1, Mazen Tawfik1, Mahmoud Mohamed Sokar1

  • 1Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Journal of Cardiovascular Echography
|May 25, 2026
PubMed

Insights

Echocardiography can predict atrial high-rate episodes (AHREs) in patients with cardiac implantable electronic devices (CIEDs). Key parameters like diastolic wall strain (DWS) and left atrial (LA) strain metrics offer high diagnostic accuracy for identifying AHREs.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Imaging

Background:

  • Atrial high-rate episodes (AHREs) detected by cardiac implantable electronic devices (CIEDs) are linked to adverse cardiovascular outcomes.
  • Identifying reliable predictors of AHREs is crucial for patient management and risk stratification.

Purpose of the Study:

  • To identify echocardiographic parameters associated with AHREs in patients with CIEDs.
  • To explore the diagnostic value of strain metrics and structural parameters for predicting AHREs.

Main Methods:

  • A cross-sectional study involving 140 patients with CIEDs, categorized into AHRE and non-AHRE groups.
  • Comprehensive echocardiographic assessments, including left atrial (LA) strain and left ventricular (LV) parameters.
  • Receiver operating characteristic (ROC) curve analysis and logistic regression for predictive accuracy and independent parameter identification.

Main Results:

  • Patients with AHREs exhibited significantly reduced diastolic wall strain (DWS) and impaired LA reservoir, conduit, and pump strain.
  • Combined LA strain metrics showed high diagnostic performance (AUC 0.956).
  • Multivariate analysis identified DWS, LA diameter, and diastolic strain variability (SDd) as independent markers of AHRE occurrence and burden.

Conclusions:

  • Echocardiographic parameters, specifically DWS, LA strain metrics, and SDd, are significant indicators in patients with AHREs.
  • Integrating strain and structural echocardiographic metrics enhances diagnostic accuracy for AHREs.
  • These findings provide valuable insights into the pathophysiology of AHREs.
Abstract

Keywords:
Atrial high-rate episodecardiac implantable electronic devicesdiastolic wall strainechocardiographyleft atrial strain

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