What to do with device-detected atrial high-rate episodes: Summary of the evidences

Contemporary Advances in Cardiac Remote Monitoring: A Comprehensive, Updated Mini-Review

Over the past decade, remote monitoring (RM) has become an increasingly popular way to improve healthcare and health outcomes. Modern cardiac implantable electronic devices (CIEDs) are capable of recording an increasing amount of data related to CIED function, arrhythmias, physiological status and hemodynamic parameters, providing in-depth and updated information on patient cardiovascular function. The extensive use of RM for patients with CIED allows for early diagnosis and rapid assessment of relevant issues, both clinical and technical, as well as replacing outpatient follow-up improving overall management without compromise safety. This approach is recommended by current guidelines for all eligible patients affected by different chronic cardiac conditions including either brady- and tachy-arrhythmias and heart failure. Beyond to clinical advantages, RM has demonstrated cost-effectiveness and is associated with elevated levels of patient satisfaction. Future perspectives include improving security, interoperability and diagnostic power as well as to engage patients with digital health technology. This review aims to update existing data concerning clinical outcomes in patients managed with RM in the wide spectrum of cardiac arrhythmias and Hear Failure (HF), disclosing also about safety, effectiveness, patient satisfaction and cost-saving.

Long duration of atrial high-rate episode is more favorable in predicting ischemic stroke than high CHA2 DS2 -VASc score

OBJECTIVE

This study aimed to explore the roles of duration and burden of atrial high-rate episode (AHRE) on ischemic stroke in patients with pacemaker implantation.

METHODS

Patients with pacemaker implantation for bradycardia from 2013 to 2017 were consecutively enrolled. Data such as gender, age, combined diseases, type of AF, left atrial size, left ventricular size, left ventricular ejection fraction, CHA2 DS2 -VASc score, and anticoagulants were collected. The burden and duration of AHRE based on different interval partition were also recorded in detail to evaluate the impacts on ischemic stroke. Cox regression analysis with time-dependent covariates was conducted.

RESULTS

A total of 220 patients with AHRE were enrolled. The average follow-up time was 48.42 ± 17.20 months. Univariate regression analysis showed that diabetes (p = .024), high CHA2 DS2 -VASc score (≥ 2) (p = .021), long mean AHRE burden (p = .011), long maximal AHRE burden (p = .015), long AHRE duration lasting≥48 h (p = .001) or 24 h (p = .001) or 12 h (p = .005) were prone to ischemic stroke. Further multivariate regression analysis showed that long duration of AHRE (≥48 h) (HR 10.77; 95% CI 3.22-55.12; p = .030) were significantly correlated with stroke in patients with paroxysmal AF. There was no significant correlation between the type of AF and stroke (p = .927).

CONCLUSION

The longer duration of AHRE (≥48 h) was more favorable in predicting ischemic stroke than high CHA2 DS2 -VASc score (≥2).

Value of ATRIA stroke risk score in predicting atrial high-rate episodes: A comparison of six different risk scores

OBJECTIVES

Atrial high-rate episodes (AHRE) are asymptomatic atrial tachy-arrhythmias detected through continuous monitoring with a cardiac implantable electronic device (CIED). AHRE's have been associated with increased risks of developing clinically manifested atrial fibrillation (AF), thromboembolism, cardiovascular events, and mortality. Several variables has been researched and identified to predict AHRE development. The aim of this study, which compared the six frequently-used scoring systems for thromboembolic risk in AF (CHA2 DS2 -VASc, mC2 HEST, HAT2 CH2 , R2 -CHADS2 , R2 -CHA2 DS2 -VASc, and ATRIA) in terms of their prognostic power in predicting AHRE.

MATERIALS AND METHODS

This retrospective study included 174 patients with CIED's. The study population was divided into two groups according to presence of AHRE: patients with AHRE (+) and patients without AHRE (-). Thereafter, patients baseline characteristics and scoring systems were analyzed for prediction of AHRE.

RESULTS

The distribution of patients' baseline characteristics and scoring systems according to presence of AHRE was evaluated. Furthermore, ROC curve analyses of the stroke risk scoring systems have been investigated in terms of predicting the development of AHREs. ATRIA, which predicted AHRE with a specificity of 92% and sensitivity of 37.5% for ATRIA values of >6, performed better than other scoring systems in predicting AHRE (AUC: 0.700, 0.626-0.767 95% confidence interval (CI), p = .004) CONCLUSION: AHRE is common in patients with a CIED. In this context, several risk scoring systems have been used to predict the development of AHRE in patients with a CIED. This study's findings revealed that The ATRIA stroke risk scoring system performed better than other commonly used risk scoring systems in predicting AHRE.