Prognostic values of atrial high-rate episodes on mortality risks in CIED patients

Abstract

Background: Recent data showed that patients with cardiac implantable electronic devices (CIEDs) who have atrial high-rate episodes (AHRE) have an increased risk of systemic thromboembolism even without a history of atrial fibrillation. However, data regarding the impact of AHRE on mortality outcomes remain conflicting. This study aims to elucidate this relationship by summarizing all available data via systematic review and meta-analysis. Methods: We systematically reviewed MEDLINE and EMBASE from inception to May 2024 to evaluate the association between AHRE and mortality risk in patients with CIED who did not have a history of atrial fibrillation at implantation. We compared all-cause and cardiovascular mortality in patients with AHRE to those without AHRE. Relative risk (RR) or hazard ratio and their 95 % confidence intervals (CIs) were extracted from each study and combined using the generic inverse variance method. Results: A total of 15 cohort studies were included in the meta-analysis. The pooled analysis showed that patients with AHRE had a higher risk of all-cause mortality compared to those without AHRE, with a pooled RR of 1.57 (95 % CI 1.21–2.03; I2 = 67 %; p < 0.001). Similarly, AHRE was associated with higher cardiovascular mortality, with a pooled RR of 1.80 (95 % CI 1.06–3.05; I2 = 49 %; p = 0.03). Conclusions: Our study found that patients with CIEDs who developed AHRE were at a higher risk of all-cause and cardiovascular mortality compared to those without AHRE.