TY - JOUR
T1 - Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence
T2 - 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
N1 - Copyright © 2021. Published by Elsevier B.V.
PY - 2021/10
Y1 - 2021/10
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 - AHRE
KW - Atrial fibrillation
KW - Atrial high rate episodes
KW - Implantable cardioverter defibrillator
KW - Pacemaker
KW - Stroke
KW - Subclinical atrial fibrillation
KW - Thromboembolism
KW - Thromboembolism a
UR - http://www.scopus.com/inward/record.url?scp=85108264191&partnerID=8YFLogxK
U2 - 10.1016/j.ejim.2021.05.038
DO - 10.1016/j.ejim.2021.05.038
M3 - Review article
C2 - 34154879
SN - 0953-6205
VL - 92
SP - 100
EP - 106
JO - European Journal of Internal Medicine
JF - European Journal of Internal Medicine
ER -