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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.

Registration Number (DOI)

Available in https://doi.org/10.17605/OSF.IO/ZRF6M.

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Data Availability

The data underlying this article are available in the article and in its online supplementary material, and its protocol can be found in https://doi.org/10.17605/OSF.IO/ZRF6M.

Code Availability

Not applicable.

Abbreviations

AF:

Atrial fibrillation

AHREs:

Atrial high-rate episodes

CIED:

Cardiac implantable electronic devices

CIs:

95% Confidence intervals

GRADE:

Grading of Recommendations, Assessment, Development and Evaluations

ICD:

Implantable cardioverter defibrillators

ICM:

Implantable cardiac monitors

NOS:

Newcastle-Ottawa Scale

OR:

Odds ratios

OAC:

Oral anticoagulant

PRISMA:

Preferred Reporting Items for Systematic reviews and Meta-Analysis

RCTs:

Randomized control trials

RoB:

Risk of bias

TIA:

Transient ischemic attack

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Author information

Author notes

  1. Ioannis Doundoulakis and Maria Gavriilaki contributed equally to this work.

Authors and Affiliations

  1. First Department of Cardiology, University of Athens Medical School, Athens, Greece

    Ioannis Doundoulakis, Petros Arsenos, Christos-Konstantinos Antoniou, Stergios Soulaidopoulos, Konstantinos A. Gatzoulis & Konstantinos Tsioufis

  2. Department of Cardiology, 424 General Military Hospital, Thessaloniki, Greece

    Ioannis Doundoulakis & Smaro Dimou

  3. First Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Maria Gavriilaki, Konstantinos Notas & Vasilios K. Kimiskidis

  4. Athens Heart Center, Athens Medical Center, Athens, Greece

    Dimitris Tsiachris

  5. First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Smaro Dimou, Ioannis Farmakis, George Giannakoulas & Stylianos Paraskevaidis

  6. Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Evangelos Akrivos

  7. Second Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Panagiotis Stoiloudis

Authors
  1. Ioannis Doundoulakis
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  2. Maria Gavriilaki
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  4. Petros Arsenos
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  6. Smaro Dimou
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  11. Konstantinos Notas
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  15. Konstantinos A. Gatzoulis
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  16. Konstantinos Tsioufis
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Contributions

ID and MG proposed the structure of the paper, critically appraised the paper, and were the major contributors in writing the manuscript. DT, PA, and CKA screened all titles and abstracts and perused full texts for eligible records; PS and KN independently extracted data from eligible studies; SS and SD assessed risk of bias and evaluated the certainty in our estimates using the GRADE approach; IF and EA proposed the statistical analysis; VK, GG, SP, KG, and KT critically appraised the paper and made the final suggestions. All authors read and approved the final manuscript.

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The authors declare no competing interest.

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Doundoulakis, I., Gavriilaki, M., Tsiachris, D. et al. Atrial High-Rate Episodes in Patients with Devices Without a History of Atrial Fibrillation: a Systematic Review and Meta-analysis. Cardiovasc Drugs Ther 36, 951–958 (2022). https://doi.org/10.1007/s10557-021-07209-8

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