Clinical Research in Cardiology

, Volume 109, Issue 1, pp 96–102 | Cite as

Atrial high-rate episodes and risk of major adverse cardiovascular events in patients with cardiac implantable electronic devices

  • Daniele Pastori
  • Kazuo Miyazawa
  • Yanguang Li
  • Orsolya Székely
  • Farhan Shahid
  • Alessio Farcomeni
  • Gregory Y. H. LipEmail author
Original Paper



Patients with atrial high-rate episodes (AHREs) are at higher risk of thromboembolic events and mortality. The risk of major adverse cardiovascular events (MACE) in these patients is unknown.


To investigate the risk of MACE in patients implanted with cardiac implantable electronic devices (CIEDs) developing AHREs

Methods and results

We included 852 consecutive patients undergoing CIEDs implantation. Primary outcome was a composite endpoint of MACEs occurring after AHREs ≥ 5 min. AHRE was defined as > 175 bpm and lasting ≥ 5 min. We also performed a subgroup analysis in patients with the longest AHRE lasting ≥ 24 h. Cox regression analysis with time-dependent covariates was used to investigate the relationship between AHREs and MACEs.

Mean age was 70.0 ± 13.6 years, and 39.3% were women: 325 patients developed AHREs ≥ 5 min [incidence rate (IR) 13.1% year 95% confidence interval (CI) 11.7–14.6] and 124 patients developed AHREs ≥ 24 h (IR 3.7%/year 95% CI 3.1–4.5). During a median follow-up of 37.0 months (IQR 19.0–64.3, 316,132 patient-years), 152 MACEs occurred (IR 4.85%/year, 95% CI 4.11–5.68). The IR of MACE occurring after AHREs onset was higher in patients developing AHREs ≥ 24 h (IR 1.13%/year) than AHREs ≥ 5 min (IR 0.63%/year, p = 0.030).

Multivariable Cox regression analysis showed that AHREs ≥ 5 min (HR 1.788, 95% CI 1.247–2.562, p = 0.002), diabetes (HR 1.909, 95% CI 1.358–2.683, p < 0.001), heart failure (HR 2.203, 95% CI 1.527–3.178, p < 0.001), and coronary artery disease (HR 1.862, 95% CI 1.293–2.681, p = 0.001) were associated to MACE. This association was even stronger for AHREs ≥ 24 h (HR 2.390, 95% CI 1.481–3.857, p < 0.001).


Patients implanted with CIEDs developing AHREs show a significant risk for MACE, which is dependent on AHREs burden. Cardiovascular prevention strategies in this patient population are warranted.

Graphic abstract


AHREs CIED MACE Implantable device Pacemaker Atrial fibrillation Myocardial infarction Cardiovascular risk 



None directly related to this manuscript.

Compliance with ethical standards

Conflict of interest

None related to this paper.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Applied Health ResearchUniversity of BirminghamBirminghamUK
  2. 2.Department of Internal Medicine and Medical Specialties, I Clinica Medica, Atherothrombosis CenterSapienza University of RomeRomeItaly
  3. 3.Department of Cardiology, Chinese PLA Medical SchoolChinese PLA General HospitalBeijingChina
  4. 4.Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
  5. 5.Liverpool Centre for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart and Chest HospitalLiverpoolUK
  6. 6.Aalborg Thrombosis Research Unit, Department of Clinical MedicineAalborg UniversityAalborgDenmark

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