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

Pasquale Vergara, Francesco Solimene, Antonio D'Onofrio, Ennio C. Pisanò, Gabriele Zanotto, Carlo Pignalberi, Saverio Iacopino, Giampiero Maglia, Paolo Della Bella, Valeria Calvi, Antonio Curnis, Gaetano Senatore, Mauro Biffi, Alessandro Capucci, Quintino Parisi, Fabio Quartieri, Fabrizio Caravati, Massimo Giammaria, Massimiliano Marini, Antonio RapacciuoloMichele Manzo, Daniele Giacopelli, Alessio Gargaro, Renato P. Ricci

Research output: Contribution to journalArticlepeer-review


Objectives: 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). Background: Clinical relevance of AHREs in terms of VA rate and survival has not been outlined yet. Methods: 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. Results: 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 < 0.001) for ventricular tachycardia (VT), 3.06 (95% CI: 2.35 to 3.99; p < 0.001) for fast VT, 1.84 (95% CI: 1.36 to 2.48; p < 0.001) for self-extinguishing ventricular fibrillation (VF), and 2.31 (95% CI: 1.17 to 4.57; p = 0.01) for VF. ORs decreased with increasing AHRE burden. Patients with AHREs 48 h before VAs were more likely to experience VA recurrences (adjusted hazard ratio [HR]: 1.78; 95% CI: 1.41 to 2.24; p < 0.001) and had higher overall mortality (HR: 2.67; 95% CI: 1.68 to 4.23; p < 0.001). Conclusions: AHREs were not uncommon 48 h before VAs, which tended to be distributed around intervals with AHREs. Temporal connection between AHREs and VAs was a marker of increased risk of VA recurrence and a poorer prognosis.

Original languageEnglish
Pages (from-to)1197-1208
Number of pages12
JournalJACC: Clinical Electrophysiology
Issue number10
Publication statusPublished - Oct 2019


  • atrial fibrillation
  • atrial high rate episodes
  • implantable cardioverter-defibrillator
  • ventricular arrhythmias
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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