Relationship between predictive factors and atrial high-rate episodes in heart failure with reduced ejection fraction patients with cardiac implantable electronic devices.

Abstract

Objective: Atrial high-rate episodes (AHRE) are atrial tachyarrhythmia episodes detected by implanted cardiac devices, characterised by an atrial rate exceeding 180-190 beats per minute. Recent studies have linked AHRE to the development of atrial fibrillation (AF) and increased stroke risk, especially when episodes last longer than 5-6 min. This study aimed to evaluate the relationship between predictive factors and the occurrence of AHRE in heart failure with reduced ejection fraction (HFrEF) patients with cardiac implantable electronic devices (CIEDs).

Methods: This single-centre, retrospective study included a cohort of 155 consecutive HFrEF patients with CIEDs, but without a diagnosis of AF, enrolled between January 2023 and December 2023. Patients were stratified based on the presence of AHRE detected during device interrogation.

Results: The average age of the patients was 54 ± 14 years, and 83.2% of the study population were male. Patients with AHRE had a reduced left ventricular ejection fraction (LVEF) (p = 0.026) and an increased left atrial diameter (p < 0.001) compared to the group without AHRE. Patients with AHRE had elevated levels of creatinine, uric acid, and TSH compared to those without AHRE (p = 0.006, p = 0.021, p = 0.009, respectively). In the univariable logistic regression analysis, LVEF (HR = 0.690, 95% CI = 0.610-0.913, p = 0.013), left atrial diameter (HR = 8.215, 95% CI = 1.557-43.34, p < 0.001), creatinine (HR = 7.369, 95% CI = 1.749-31.05, p = 0.006), uric acid (HR = 1.073, 95% CI = 1.062-1.196, p = 0.020), total cholesterol (HR = 0.989, 95% CI = 0.979-0.999, p = 0.031), and C-reactive protein levels (HR = 1.146, 95% CI = 1.002-1.131, p = 0.047) were identified as independent predictors of AHRE. In multivariable logistic regression analysis, left ventricular ejection fraction (HR = 0.890, 95% CI = 0.795-0.998, p = 0.046), left atrial diameter (HR = 8.215, 95% CI = 1.557-43.34, p < 0.001), and uric acid concentration (HR = 1.650, 95% CI = 1.063-2.561, p = 0.025) were identified as predictors of atrial high-rate events.

Conclusion: LVEF, left atrial diameter, and uric acid level were found to be independent predictors of AHRE in patients with HFrEF. Identifying AHRE is crucial for risk stratification and guiding therapeutic decisions to improve patient outcome.