Are Atrial High-Rate Episodes Associated With Increased Risk of Ventricular Arrhythmias and Mortality?

• Published in: JACC. Clinical electrophysiology 2019-10, Vol.5 (10), p.1197-1208
• Main Authors: Vergara, Pasquale, Solimene, Francesco, D'Onofrio, Antonio, Pisanò, Ennio C., Zanotto, Gabriele, Pignalberi, Carlo, Iacopino, Saverio, Maglia, Giampiero, Della Bella, Paolo, Calvi, Valeria, Curnis, Antonio, Senatore, Gaetano, Biffi, Mauro, Capucci, Alessandro, Parisi, Quintino, Quartieri, Fabio, Caravati, Fabrizio, Giammaria, Massimo, Marini, Massimiliano, Rapacciuolo, Antonio, Manzo, Michele, Giacopelli, Daniele, Gargaro, Alessio, Ricci, Renato P.
• Format: Article
• Language: English
• Subjects: atrial fibrillation; atrial high rate episodes; implantable cardioverter-defibrillator; ventricular arrhythmias; ventricular tachycardia
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2019.06.018

This study evaluated the temporal association between atrial high-rate episodes (AHREs) and sustained ventricular arrhythmias (VAs) in a remotely monitored cohort with implantable cardioverter-defibrillators (ICD) with and/or without cardiac resynchronization therapy with a defibrillator (CRT-D). Clinical relevance of AHREs in terms of VA rate and survival has not been outlined yet. This study analyzed data of patients with ICDs and CRT-Ds from the nationwide Home Monitoring Expert Alliance network. The cohort included 2,435 patients with a median follow-up of 25 months (interquartile range: 13 to 42 months) and age 70 years (range 61 to 77 years); 19.7% were women, 51.4% had coronary artery disease, and 45.2% had a CRT-D. There were 3,410 appropriate VA episodes; 498 (14.6%) were preceded by AHREs within 48 h; in 85.5% of this group, AHREs were still ongoing at episode onset. In a longitudinal analysis, the odds ratios (ORs) of experiencing any VA in a 30-day interval with AHREs versus intervals without AHREs were 2.35 (95% confidence interval [CI]: 1.86 to 2.97; p