Association of atrial high-rate episodes daily burden with the risk of cardiovascular death, heart failure hospitalization, and stroke.
Journal
Heart rhythm
ISSN
1556-3871
Date Issued
2026-03-04
Author(s)
Botto, Giovanni Luca
Pisanò, Ennio C L
Rapacciuolo, Antonio
Lazzari, Ludovico
Bontempi, Luca
Pelargonio, Gemma
Arena, Giuseppe
Caccavo, Vincenzo
Wang, Chun-Chieh
Merkley, Béla
Oh, Il-Young
Bertaglia, Emanuele
Dell'Era, Gabriele
Chen, Ju-Yi
Choi, Eue-Keun
Zingarini, Gianluca
Piemontese, Carlo
Del Maestro, Martina
Giacopelli, Daniele
Gargaro, Alessio
Calvi, Valeria
Abstract
Background The clinical significance of device-detected atrial high-rate episodes (AHREs) is believed to increase with AHRE burden. Objective This study evaluated whether a daily burden ≥6 minutes is associated with major cardiovascular (CV) outcomes. Methods We analyzed 1160 patients with sinus node dysfunction and dual-chamber pacemakers or defibrillators from the B3 randomized trial, followed for 3 years. The primary composite end point included CV death, worsening heart failure hospitalization (WHFH), and stroke or transient ischemic attack (TIA). Secondary end points were individual components of the primary end point and progression to long-lasting AF. Using competing-risk survival models with AHRE burden as a time-varying covariate, we calculated CHA2DS2-VASc-adjusted hazard ratios (HRs) after the first day with burden ≥6 minutes. AHREs were all adjudicated. Results AHRE burden ≥6 minutes occurred in 52.5% of patients, 47.1% of whom had no prior AF. There were 65 primary events (10 CV deaths, 39 WHFHs, 16 strokes/TIAs). In patients without prior AF, AHRE burden ≥6 minutes was significantly associated with the primary end point (HR 4.9; 95% confidence interval [CI], 2.19-10.91; P <.001), and with CV death (P =.033), WHFH (P <.001), and long-lasting AF (P <.001), but not with stroke/TIA (P =.34). In contrast, no significant association was found in patients with prior AF (HR 0.83; 95% CI, 0.37-1.87; P =.65). Conclusion In patients without prior AF, a daily AHRE burden ≥6 minutes was linked to a >4-fold increased risk of major CV events, mainly driven by CV death, WHFH, and progression to long-lasting AF. No such association was observed in patients with prior AF.
Subjects
AHRE burden
Cardiovascular death
Device-detected atrial fibrillation
Risk of cardiovascular events
Stroke
Worsening heart failure hospitalization
Type
journal article