Atrial High-Rate Episodes in Patients with Devices Without a History of
Atrial Fibrillation: a Systematic Review and Meta-analysis
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Abstract
Purpose Atrial high-rate episodes (AHREs) recorded with cardiac
implantable electronic devices (CIEDs) have been associated with the
development of clinical atrial fibrillation (AF) and increase in stroke
and death risk. We sought to perform a systematic review with a
meta-analysis to evaluate the prevalence of AHREs detected by CIEDs,
their association with stroke risk, development of clinical AF, and
mortality among patients without a documented history of AF.
Methods We searched several databases, ClinicalTrials.gov, references of
reviews, and meeting abstract books without any language restrictions up
to 9 September 2020. We studied patients with CIEDs in whom AHREs were
detected. Exclusion criterion was AF history. Our primary outcome was
the risk of ischemic stroke in patients with AHREs.
Results We deemed eligible eight studies for the meta-analysis enrolling
a total of 4322 patients with CIED and without a documented AF history.
The overall AHRE incidence ratio was estimated to be 17.56 (95% CI,
8.61 to 35.79) cases per 100 person-years. Evidence of moderate
certainty suggests that patients with documented AHREs were 4.45 times
(95% CI 2.87-6.91) more likely to develop clinical AF. Evidence of low
confidence suggests that AHREs were associated with a 1.90-fold
increased stroke risk (95% CI 1.19-3.05). AHREs were not associated
with a statistically significant increased mortality risk.
Conclusion The present systematic review and meta-analysis demonstrated
that among patients without a documented history of AF, the detection of
AHREs by CIEDs was associated with significant increased risk of
clinical AF and stroke