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Prevalence and Predictors of Clinically Relevant Atrial High-Rate Episodes in Patients with Cardiac Implantable Electronic Devices

 Min Kim  ;  Tae Hoon Kim  ;  Hee Tae Yu  ;  Eue Keun Choi  ;  Hyung Seob Park  ;  Junbeom Park  ;  Young Soo Lee  ;  Ki Woon Kang  ;  Jaemin Shim  ;  Jung Hoon Sung  ;  Il Young Oh  ;  Boyoung Joung 
 KOREAN CIRCULATION JOURNAL, Vol.51(3) : 235-247, 2021-03 
Journal Title
Issue Date
Arrhythmia ; Left atrium ; Pacemaker, artificial ; Sick sinus syndrome
Background and objectives: Atrial high-rate episodes (AHREs) can be continuously detected by cardiovascular implantable electronic devices (CIEDs); however, the predictors of clinically relevant AHREs are unclear. Methods: This prospective multicenter study monitored 816 patients (median age 73 years, 40.4% male) without atrial fibrillation (AF) from September 2017 to July 2020. AHREs was defined as a programmed atrial detection rate >220 beats/min. The reference values of 6 minutes and 6 hours were set to analyze clinical implication of AHREs based on previously published data that the 6 minutes excluded most episodes of oversensing. Results: During a median follow-up of 18 months (interquartile interval 9-26 months), AHREs with the longest durations of >15 seconds, >6 minutes, and >6 hours and clinically documented AF by electrocardiography were noted in 246 (30.1%), 112 (13.7%), 49 (6.0%), and 24 (2.9%) patients, respectively. Among patients developing AHREs >6 minutes, 102 (91.1%) of 112 patients were identified at the 6-month visit. Patients with AHREs >6 minutes had higher proportions of sick sinus syndrome, subjects with atrial premature beat >1% on Holter monitoring, and larger left atrium (LA) size than patients with AHREs ≤6 minutes. Multivariable logistic regression analysis showed that LA diameter >41 mm (odds ratio [OR], 2.08; 95% confidence interval [95% CI], 1.25-3.45), and sick sinus syndrome (OR, 3.22; 95% CI, 1.91-5.43) were associated with AHREs >6 minutes. Conclusions: In patients with LA diameter >41 mm, and sick sinus syndrome before CIEDs implantation is associated with risk of developing AHREs >6 minutes. Trial registration: ClinicalTrials.gov Identifier: NCT03303872.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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