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Original research
Clinical significance of atrial high-rate episodes for thromboembolic events in Japanese population
  1. Hiroshi Kawakami1,
  2. Takayuki Nagai1,
  3. Makoto Saito2,
  4. Shinji Inaba2,
  5. Fumiyasu Seike1,
  6. Kazuhisa Nishimura1,
  7. Katsuji Inoue1,
  8. Takafumi Okura1,
  9. Takumi Sumimoto2,
  10. Shigeki Uemura3,
  11. Jitsuo Higaki1,
  12. Shuntaro Ikeda1
  1. 1Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
  2. 2Division of Cardiology, Kitaishikai Hospital, Ehime, Japan
  3. 3Division of Cardiology, Yawatahama City General Hospital, Ehime, Japan
  1. Correspondence to Dr Takayuki Nagai, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan; nagait{at}m.ehime-u.ac.jp

Abstract

Objective The clinical significance of atrial high-rate episodes (AHREs) detected by cardiac devices among patients with implantable pacemakers has recently emerged. However, the relationship between AHREs and ischaemic stroke and systemic embolism (SE) is not well understood in the Japanese population.

Methods This study included 343 patients with pacemakers capable of continuous atrial rhythm monitoring (167 males; mean age, 80±7 years). Atrial tachyarrhythmia detection was programmed to the nominal setting of each device, and AHRE was defined as any episode of sustained atrial tachyarrhythmia lasting for more than 6 min. Thromboembolic risk was defined based on the CHADS2 score.

Results During the follow-up period (52±30 months), 165 (48%) patients had at least one episode of AHREs, and 19 (6%) patients experienced stroke/SE. Among patients who experienced stroke/SE, 14 had AHREs before the stroke/SE. AHREs were significantly associated with stroke/SE (HR 2.87; 95% CI 1.10 to 8.90; p=0.03). Subgroup analysis conducted to investigate the impact of the CHADS2 score severity on stroke/SE revealed that AHREs were not associated with stroke/SE in patients with low or intermediate thromboembolic risk (CHADS2 score 0–2; n=217). In contrast, among patients with high thromboembolic risk (CHADS2 score>2; n=126), there was a significant association between AHREs and the incidence of stroke/SE (HR 3.73; 95% CI 1.06 to 13.1; p=0.04).

Conclusion AHREs detected by pacemaker were associated with ischaemic stroke/SE in the Japanese population. However, this association was observed only in the high thromboembolic risk group.

  • atrial fibrillation
  • pacemakers
  • stroke

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/heartasia-2017-010954

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    Footnotes

    • Contributors HK, TN, MS and SI planned the study and conducted a survey. FS, KN and KI conducted a survey. TO, TS, SU, JH and SI planned the study and revised the final manuscript. All authors approved the manuscript as submitted.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The ethics committees of Ehime University Graduate School of Medicine.

    • Provenance and peer review Not commissioned; externally peer reviewed.