Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis

Marco Vitolo; Jacopo F Imberti; Anna Maisano; Alessandro Albini; Niccolò Bonini; Anna Chiara Valenti; Vincenzo L Malavasi; Marco Proietti; Jeff S Healey; Gregory YH Lip; Giuseppe Boriani

doi:10.1016/j.ejim.2021.05.038

Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis

Marco Vitolo, Jacopo F Imberti, Anna Maisano, Alessandro Albini, Niccolò Bonini, Anna Chiara Valenti, Vincenzo L Malavasi, Marco Proietti, Jeff S Healey, Gregory YH Lip, Giuseppe Boriani

Research output: Contribution to journal › Article › peer-review

Abstract

Background Atrial High Rate Episodes (AHRE) are asymptomatic atrial tachy-arrhythmias detected through continuous monitoring with a cardiac implantable electronic device. The risks of stroke/Thromboembolic (TE) events and incident clinical Atrial Fibrillation (AF) associated with AHRE varies markedly. Objectives To assess the relationship between AHRE and TE events, and between AHRE and incident clinical AF. Methods This systematic review and meta-analysis was conducted following the PRISMA recommendations. PubMed, Scopus, and Google Scholar were searched from inception to 18/02/2021 for studies reporting TE events and incident clinical AF in patients with AHRE, as compared with patients without. Results Ten out of 8081 records fulfilled the inclusion criteria, for a total of 37 266 patients. Seven out of ten studies excluded patients with prior history of clinical AF (4961 patients), embracing the most recent definition of AHRE. The risk ratio (RR) for TE events in AHRE patients was 2.13 (95% CI: 1.53–2.95, I2: 0%). The incidence of clinical AF was reported in four studies excluding patients with a history of clinical AF (3574 patients). The RR for incident clinical AF was 3.34 (95%CI: 1.89–5.90, I2: 73%). Conclusions AHRE are significantly associated with systemic thromboembolism and incident clinical AF. Further studies are needed to improve patients' risk stratification and management.

Original language	English
Pages (from-to)	100-106
Number of pages	7
Journal	Eur. J. Intern. Med.
Volume	92
DOIs	https://doi.org/10.1016/j.ejim.2021.05.038
Publication status	Published - 2021

Keywords

Subclinical atrial fibrillation
Stroke
AHRE
Pacemaker
Atrial fibrillation
Atrial high rate episodes
Thromboembolism a
Implantable cardioverter defibrillator
Thromboembolism

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10.1016/j.ejim.2021.05.038

https://www.sciencedirect.com/science/article/pii/S0953620521001977

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Vitolo, M., Imberti, J. F., Maisano, A., Albini, A., Bonini, N., Valenti, A. C., Malavasi, V. L., Proietti, M., Healey, J. S., Lip, G. YH., & Boriani, G. (2021). Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis. Eur. J. Intern. Med., 92, 100-106. https://doi.org/10.1016/j.ejim.2021.05.038

Vitolo, M, Imberti, JF, Maisano, A, Albini, A, Bonini, N, Valenti, AC, Malavasi, VL, Proietti, M, Healey, JS, Lip, GYH & Boriani, G 2021, 'Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis', Eur. J. Intern. Med., vol. 92, pp. 100-106. https://doi.org/10.1016/j.ejim.2021.05.038

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title = "Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis",

abstract = "Background Atrial High Rate Episodes (AHRE) are asymptomatic atrial tachy-arrhythmias detected through continuous monitoring with a cardiac implantable electronic device. The risks of stroke/Thromboembolic (TE) events and incident clinical Atrial Fibrillation (AF) associated with AHRE varies markedly. Objectives To assess the relationship between AHRE and TE events, and between AHRE and incident clinical AF. Methods This systematic review and meta-analysis was conducted following the PRISMA recommendations. PubMed, Scopus, and Google Scholar were searched from inception to 18/02/2021 for studies reporting TE events and incident clinical AF in patients with AHRE, as compared with patients without. Results Ten out of 8081 records fulfilled the inclusion criteria, for a total of 37 266 patients. Seven out of ten studies excluded patients with prior history of clinical AF (4961 patients), embracing the most recent definition of AHRE. The risk ratio (RR) for TE events in AHRE patients was 2.13 (95% CI: 1.53–2.95, I2: 0%). The incidence of clinical AF was reported in four studies excluding patients with a history of clinical AF (3574 patients). The RR for incident clinical AF was 3.34 (95%CI: 1.89–5.90, I2: 73%). Conclusions AHRE are significantly associated with systemic thromboembolism and incident clinical AF. Further studies are needed to improve patients' risk stratification and management.",

keywords = "Subclinical atrial fibrillation, Stroke, AHRE, Pacemaker, Atrial fibrillation, Atrial high rate episodes, Thromboembolism a, Implantable cardioverter defibrillator, Thromboembolism",

author = "Marco Vitolo and Imberti, {Jacopo F} and Anna Maisano and Alessandro Albini and Niccol{\`o} Bonini and Valenti, {Anna Chiara} and Malavasi, {Vincenzo L} and Marco Proietti and Healey, {Jeff S} and Lip, {Gregory YH} and Giuseppe Boriani",

year = "2021",

doi = "10.1016/j.ejim.2021.05.038",

language = "English",

volume = "92",

pages = "100--106",

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T1 - Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis

AU - Vitolo, Marco

AU - Imberti, Jacopo F

AU - Maisano, Anna

AU - Albini, Alessandro

AU - Bonini, Niccolò

AU - Valenti, Anna Chiara

AU - Malavasi, Vincenzo L

AU - Proietti, Marco

AU - Healey, Jeff S

AU - Lip, Gregory YH

AU - Boriani, Giuseppe

PY - 2021

Y1 - 2021

N2 - Background Atrial High Rate Episodes (AHRE) are asymptomatic atrial tachy-arrhythmias detected through continuous monitoring with a cardiac implantable electronic device. The risks of stroke/Thromboembolic (TE) events and incident clinical Atrial Fibrillation (AF) associated with AHRE varies markedly. Objectives To assess the relationship between AHRE and TE events, and between AHRE and incident clinical AF. Methods This systematic review and meta-analysis was conducted following the PRISMA recommendations. PubMed, Scopus, and Google Scholar were searched from inception to 18/02/2021 for studies reporting TE events and incident clinical AF in patients with AHRE, as compared with patients without. Results Ten out of 8081 records fulfilled the inclusion criteria, for a total of 37 266 patients. Seven out of ten studies excluded patients with prior history of clinical AF (4961 patients), embracing the most recent definition of AHRE. The risk ratio (RR) for TE events in AHRE patients was 2.13 (95% CI: 1.53–2.95, I2: 0%). The incidence of clinical AF was reported in four studies excluding patients with a history of clinical AF (3574 patients). The RR for incident clinical AF was 3.34 (95%CI: 1.89–5.90, I2: 73%). Conclusions AHRE are significantly associated with systemic thromboembolism and incident clinical AF. Further studies are needed to improve patients' risk stratification and management.

AB - Background Atrial High Rate Episodes (AHRE) are asymptomatic atrial tachy-arrhythmias detected through continuous monitoring with a cardiac implantable electronic device. The risks of stroke/Thromboembolic (TE) events and incident clinical Atrial Fibrillation (AF) associated with AHRE varies markedly. Objectives To assess the relationship between AHRE and TE events, and between AHRE and incident clinical AF. Methods This systematic review and meta-analysis was conducted following the PRISMA recommendations. PubMed, Scopus, and Google Scholar were searched from inception to 18/02/2021 for studies reporting TE events and incident clinical AF in patients with AHRE, as compared with patients without. Results Ten out of 8081 records fulfilled the inclusion criteria, for a total of 37 266 patients. Seven out of ten studies excluded patients with prior history of clinical AF (4961 patients), embracing the most recent definition of AHRE. The risk ratio (RR) for TE events in AHRE patients was 2.13 (95% CI: 1.53–2.95, I2: 0%). The incidence of clinical AF was reported in four studies excluding patients with a history of clinical AF (3574 patients). The RR for incident clinical AF was 3.34 (95%CI: 1.89–5.90, I2: 73%). Conclusions AHRE are significantly associated with systemic thromboembolism and incident clinical AF. Further studies are needed to improve patients' risk stratification and management.

KW - Subclinical atrial fibrillation

KW - Stroke

KW - AHRE

KW - Pacemaker

KW - Atrial fibrillation

KW - Atrial high rate episodes

KW - Thromboembolism a

KW - Implantable cardioverter defibrillator

KW - Thromboembolism

U2 - 10.1016/j.ejim.2021.05.038

DO - 10.1016/j.ejim.2021.05.038

M3 - Article

SN - 0953-6205

VL - 92

SP - 100

EP - 106

JO - Eur. J. Intern. Med.

JF - Eur. J. Intern. Med.

ER -

Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis

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Keywords

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