Abstract 16242: Incidence and Clinical Significance of New Onset Device-Detected Atrial Tachyarrhythmia: A Meta-Analysis
Introduction: The association between atrial fibrillation (AF) and risk for thromboembolic events (TE) is established. Despite this, the clinical significance of new onset device-detected atrial tachyarrhythmia (DDAT) in predicting TE remains disputed.
Hypothesis: We hypothesized that, compared to patients with no prior history of atrial tachyarrhythmia (AT) or AF, there is an increased risk of TE in patients with new-onset DDAT.
Methods: A literature search of the OVID Medline, Cochrane, and Scopus databases (inception through February 13, 2016) was conducted. Randomized control trials, prospective and retrospective studies reporting incidence of DDAT in patients with cardiac implantable electronic devices (CIEDs) were selected for meta-analysis.
Results: Of 4,253 reports identified, 19 studies following 15,173 patients were included for review. Average age was 70.6 years, 34.1% were female, and 58.8% had a history of heart failure. At the time of study initiation 12,941 subjects (85.3%) had no prior history of AT. New-onset DDAT was observed in 3,533 patients (27.3%) over a mean study duration of 24.9 ± 17.2 months. Among 7 studies reporting TE in 6,329 patients, the overall incidence of TE was 2.3%, over a mean follow-up time of 29 ± 15.3 months. The diagnostic threshold for new-onset DDAT in these studies ranged from arrhythmias ≥ 30 seconds to ≥14 minutes, with 71.4% of studies using a cutoff of 6 minutes or less. The risk of TE was significantly greater among patients with new onset DDAT (RR 2.27, CI 1.44-3.58, p=0.0004), with a low degree of statistical heterogeneity (I2=16%) (see Figure).
Conclusions: New-onset DDAT is common, affecting over one-quarter of all CIED patients. Although uncertainty exists regarding individual risk in diverse patient populations, DDAT appears associated with a significantly increased risk for thromboembolism, even when overall threshold for detection is short.
Figure: Risk of TE events in patients with DDAT vs. no DDAT
Author Disclosures: M.N. Belkin: None. C. Soria: None. C. Borleffs: None. J.P. Singh: None. R. Tung: None. G.A. Upadhyay: None.
- © 2016 by American Heart Association, Inc.