Association of device-detected atrial high-rate episodes with long-term cardiovascular and all-cause mortality: a cohort study

BACKGROUND:Device-detected atrial high-rate episodes (AHRE) were associated with an increased thromboembolic risk. While limited data regarding the long-term prognosis of patients with AHRE were controversial, this study aimed to identify the association of device-detected AHRE with mortality. METHODS:This observational study included patients with ICD or CRT-D implantation and no history of AF, atrial flutter (AFL) or atrial tachycardia (AT). During follow-up, patients with at least one day of AHRE duration ≥15 minutes were identified. The primary endpoint was cardiovascular mortality and the secondary endpoint was all-cause mortality. RESULTS:During a mean follow-up period of 4.2 years, AHRE were detected in 124 of 343 (36.2%) patients. Of these, 44 death (35.5%) occurred in 124 patients with AHRE, which was significantly higher than those without AHRE (43/219, 19.6%, P=0.001). The multivariate analysis revealed that patients with AHRE had a significantly higher risk of cardiovascular (HR: 2.40, 95% CI: 1.23-4.67, P=0.010) and all-cause mortality (HR: 2.31, 95% CI: 1.49-3.59, P<0.001). Further analysis indicated that this association remained significant in patients with higher burden (≥6 hours), but not in patients with lower burden (≥15 minutes-6 hours). Notably, even after excluding the patients diagnosed with clinical AF during follow-up, the remaining patients with AHRE still exhibited a higher risk of cardiovascular and all-cause mortality compared to patients without AHRE. CONCLUSION:AHRE were prevalent in ICD or CRT-D recipients with no history of clinical AF, AFL or AT and were associated with more than twice the risk of cardiovascular and all-cause mortality.