Abstract 13360: Newly Detected Atrial High Rate Episodes in Pacemaker Patients are Associated With Increased Mortality Over Long Term Follow-up
Background: Subclinical episodes of atrial high rate episodes (AHREs) detected by implanted devices in pts with no prior history of atrial fibrillation (AF) have been associated with an increased risk of stroke and systemic embolism. Data regarding the long-term survival of pts with pacemakers (PPMs) and newly detected AHREs are limited.
Objective: To assess whether AHREs detected by PPMs in pts with no prior history of AF predict all-cause mortality and cardiovascular mortality over long term follow-up.
Methods: We evaluated 259 pts (age 74 ± 12 yrs; 140 (54%) male) with no prior history of AF who underwent dual chamber PPM implantation at our institution from 2002 through 2004. Baseline demographics and clinical characteristics were recorded. During PPM follow-up, the presence of AHREs (defined as AT/AF with rate cut-off 177 ± 12 bpm of ≥ 5 mins duration) were recorded. Patients with AHREs within 1 year of PPM implantation were identified. Mortality data were obtained from the National Death Index.
Results: Over mean follow-up of 6.5 ± 2.0 yrs, a total of 59 (23%) pts had AHREs ≥ 5 mins duration within 1 yr of PPM implantation. In a Cox proportional hazards model adjusted for age, coronary artery disease, congestive heart failure, diabetes, and hypertension, newly detected AHREs was associated with a significant increase in all-cause mortality (HR 1.8; 95% CI 1.1 - 3.0; p = 0.02). Moreover, AHREs within 1 year of device implantation were also significantly predictive of cardiovascular death (HR 2.4; 95% CI: 1.2 - 4.8; p = 0.015) and stroke-associated death (HR 7.6; 95% CI: 1.1 - 50.7; p = 0.037).
Conclusion: Newly detected AHREs ≥ 5 mins duration are commonly encountered in PPM pts with no prior history of AF and are significantly associated with all-cause mortality, cardiac death and stroke-related death over long term follow-up.
- © 2013 by American Heart Association, Inc.