Newly detected atrial high rate episodes predict long-term mortality outcomes in patients with permanent pacemakers
Background Subclinical atrial high rate episodes (AHREs) detected by implanted devices in patients with no history of atrial fibrillation (AF) have been associated with an increased risk of stroke and systemic embolism. Data regarding the long-term survival of patients with permanent pacemakers and...
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| Veröffentlicht in: | Heart rhythm 2014-12, Vol.11 (12), p.2214-2221 |
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| creator | Gonzalez, Maday, MD Keating, Richard J., MD Markowitz, Steven M., MD, FHRS Liu, Christopher F., MD, FHRS Thomas, George, MD Ip, James E., MD, FHRS Lerman, Bruce B., MD, FHRS Cheung, Jim W., MD, FHRS |
| description | Background Subclinical atrial high rate episodes (AHREs) detected by implanted devices in patients with no history of atrial fibrillation (AF) have been associated with an increased risk of stroke and systemic embolism. Data regarding the long-term survival of patients with permanent pacemakers and newly detected AHREs are limited. Objective This study aimed to assess whether newly detected AHREs in pacemaker patients predict mortality outcomes. Methods We evaluated 224 patients (mean age 74 ± 12 years; 118 men [53%]) with no history of AF who underwent dual-chamber pacemaker implantation from 2002 through 2004. During follow-up, patients with AHREs of ≥5-minute duration were identified. Mortality data were obtained from the National Death Index. Results Thirty-nine patients (17%) had AHREs of ≥5-minute duration within 6 months of pacemaker implantation. Over a mean follow-up period of 6.6 ± 2.0 years, the rate of all-cause mortality was 29%. In multivariate analysis adjusted for age, sex, and cardiovascular diseases, AHREs were associated with a significant increase in cardiovascular mortality (hazard ratio [HR] 2.80; 95% confidence interval [CI] 1.24–6.31; P = .013) and stroke mortality (HR 9.65; 95% CI 1.56–59.9; P = .015), with a trend toward increased all-cause mortality (HR 1.79; 95% CI 0.98–3.26; P = .059). The subgroup of patients with AHREs of ≥5-minute but |
| doi_str_mv | 10.1016/j.hrthm.2014.08.019 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1629956244</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1547527114009023</els_id><sourcerecordid>1629956244</sourcerecordid><originalsourceid>FETCH-LOGICAL-c484t-ee7047094479da3be1f05e9e8cd9e968860294bd6a8b903a8ce5fc1629d60803</originalsourceid><addsrcrecordid>eNqFkU2P1SAUhonROB_6C0wMSzeth5ZSWGhiJjqaTHTh7AkXzp1ypy0VqJP776Xe0YUbV3zkeTmc5xDyikHNgIm3h3qIeZjqBhivQdbA1BNyzrpOVK3s2dNtz_uqa3p2Ri5SOgA0SkD7nJw1HWuZEP05SV_xYTxShxltRkdNjt6MdPB3A40mI8XFp-Aw0SWi8zbTMcx3VcY40SnEbEafjzSs2YapQH6mi8ke55zog88DXQpo5nIu9xYnc48xvSDP9mZM-PJxvSS3nz7eXn2ubr5df7n6cFNZLnmuEHvgPSjOe-VMu0O2hw4VSusUKiGlKP3wnRNG7hS0Rlrs9paJRjkBEtpL8ub07BLDjxVT1pNPFsex_CesSW-k6kTDeUHbE2pjSCniXi_RTyYeNQO9ydYH_Vu23mRrkLrILqnXjwXW3YTub-aP3QK8OwFYuvzpMepkixtbRMaiW7vg_1Pg_T95O_rZWzPe4xHTIaxxLgI106nRoL9v897GzTiAgqZtfwHrYah9</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1629956244</pqid></control><display><type>article</type><title>Newly detected atrial high rate episodes predict long-term mortality outcomes in patients with permanent pacemakers</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Gonzalez, Maday, MD ; Keating, Richard J., MD ; Markowitz, Steven M., MD, FHRS ; Liu, Christopher F., MD, FHRS ; Thomas, George, MD ; Ip, James E., MD, FHRS ; Lerman, Bruce B., MD, FHRS ; Cheung, Jim W., MD, FHRS</creator><creatorcontrib>Gonzalez, Maday, MD ; Keating, Richard J., MD ; Markowitz, Steven M., MD, FHRS ; Liu, Christopher F., MD, FHRS ; Thomas, George, MD ; Ip, James E., MD, FHRS ; Lerman, Bruce B., MD, FHRS ; Cheung, Jim W., MD, FHRS</creatorcontrib><description>Background Subclinical atrial high rate episodes (AHREs) detected by implanted devices in patients with no history of atrial fibrillation (AF) have been associated with an increased risk of stroke and systemic embolism. Data regarding the long-term survival of patients with permanent pacemakers and newly detected AHREs are limited. Objective This study aimed to assess whether newly detected AHREs in pacemaker patients predict mortality outcomes. Methods We evaluated 224 patients (mean age 74 ± 12 years; 118 men [53%]) with no history of AF who underwent dual-chamber pacemaker implantation from 2002 through 2004. During follow-up, patients with AHREs of ≥5-minute duration were identified. Mortality data were obtained from the National Death Index. Results Thirty-nine patients (17%) had AHREs of ≥5-minute duration within 6 months of pacemaker implantation. Over a mean follow-up period of 6.6 ± 2.0 years, the rate of all-cause mortality was 29%. In multivariate analysis adjusted for age, sex, and cardiovascular diseases, AHREs were associated with a significant increase in cardiovascular mortality (hazard ratio [HR] 2.80; 95% confidence interval [CI] 1.24–6.31; P = .013) and stroke mortality (HR 9.65; 95% CI 1.56–59.9; P = .015), with a trend toward increased all-cause mortality (HR 1.79; 95% CI 0.98–3.26; P = .059). The subgroup of patients with AHREs of ≥5-minute but <1-day duration still had a significantly increased cardiovascular mortality (HR 3.24; 95% CI 1.37–7.66; P = .007). Conclusion AHREs are commonly encountered in pacemaker patients with no history of AF and are independent predictors of cardiovascular mortality.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2014.08.019</identifier><identifier>PMID: 25131667</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Analysis of Variance ; Atrial fibrillation ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - mortality ; Atrial Fibrillation - therapy ; Cardiac Pacing, Artificial - adverse effects ; Cardiac Pacing, Artificial - methods ; Cardiovascular ; Cause of Death ; Cohort Studies ; Electrocardiography - methods ; Embolism - etiology ; Embolism - mortality ; Embolism - physiopathology ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Mortality ; Multivariate Analysis ; Pacemaker, Artificial ; Permanent pacemaker ; Predictive Value of Tests ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Stroke - etiology ; Stroke - mortality ; Stroke - physiopathology ; Survival Analysis ; Time Factors ; Treatment Outcome</subject><ispartof>Heart rhythm, 2014-12, Vol.11 (12), p.2214-2221</ispartof><rights>Heart Rhythm Society</rights><rights>2014 Heart Rhythm Society</rights><rights>Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c484t-ee7047094479da3be1f05e9e8cd9e968860294bd6a8b903a8ce5fc1629d60803</citedby><cites>FETCH-LOGICAL-c484t-ee7047094479da3be1f05e9e8cd9e968860294bd6a8b903a8ce5fc1629d60803</cites><orcidid>0000-0002-4403-1330</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527114009023$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25131667$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gonzalez, Maday, MD</creatorcontrib><creatorcontrib>Keating, Richard J., MD</creatorcontrib><creatorcontrib>Markowitz, Steven M., MD, FHRS</creatorcontrib><creatorcontrib>Liu, Christopher F., MD, FHRS</creatorcontrib><creatorcontrib>Thomas, George, MD</creatorcontrib><creatorcontrib>Ip, James E., MD, FHRS</creatorcontrib><creatorcontrib>Lerman, Bruce B., MD, FHRS</creatorcontrib><creatorcontrib>Cheung, Jim W., MD, FHRS</creatorcontrib><title>Newly detected atrial high rate episodes predict long-term mortality outcomes in patients with permanent pacemakers</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Background Subclinical atrial high rate episodes (AHREs) detected by implanted devices in patients with no history of atrial fibrillation (AF) have been associated with an increased risk of stroke and systemic embolism. Data regarding the long-term survival of patients with permanent pacemakers and newly detected AHREs are limited. Objective This study aimed to assess whether newly detected AHREs in pacemaker patients predict mortality outcomes. Methods We evaluated 224 patients (mean age 74 ± 12 years; 118 men [53%]) with no history of AF who underwent dual-chamber pacemaker implantation from 2002 through 2004. During follow-up, patients with AHREs of ≥5-minute duration were identified. Mortality data were obtained from the National Death Index. Results Thirty-nine patients (17%) had AHREs of ≥5-minute duration within 6 months of pacemaker implantation. Over a mean follow-up period of 6.6 ± 2.0 years, the rate of all-cause mortality was 29%. In multivariate analysis adjusted for age, sex, and cardiovascular diseases, AHREs were associated with a significant increase in cardiovascular mortality (hazard ratio [HR] 2.80; 95% confidence interval [CI] 1.24–6.31; P = .013) and stroke mortality (HR 9.65; 95% CI 1.56–59.9; P = .015), with a trend toward increased all-cause mortality (HR 1.79; 95% CI 0.98–3.26; P = .059). The subgroup of patients with AHREs of ≥5-minute but <1-day duration still had a significantly increased cardiovascular mortality (HR 3.24; 95% CI 1.37–7.66; P = .007). Conclusion AHREs are commonly encountered in pacemaker patients with no history of AF and are independent predictors of cardiovascular mortality.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis of Variance</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - mortality</subject><subject>Atrial Fibrillation - therapy</subject><subject>Cardiac Pacing, Artificial - adverse effects</subject><subject>Cardiac Pacing, Artificial - methods</subject><subject>Cardiovascular</subject><subject>Cause of Death</subject><subject>Cohort Studies</subject><subject>Electrocardiography - methods</subject><subject>Embolism - etiology</subject><subject>Embolism - mortality</subject><subject>Embolism - physiopathology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Pacemaker, Artificial</subject><subject>Permanent pacemaker</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Stroke - etiology</subject><subject>Stroke - mortality</subject><subject>Stroke - physiopathology</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU2P1SAUhonROB_6C0wMSzeth5ZSWGhiJjqaTHTh7AkXzp1ypy0VqJP776Xe0YUbV3zkeTmc5xDyikHNgIm3h3qIeZjqBhivQdbA1BNyzrpOVK3s2dNtz_uqa3p2Ri5SOgA0SkD7nJw1HWuZEP05SV_xYTxShxltRkdNjt6MdPB3A40mI8XFp-Aw0SWi8zbTMcx3VcY40SnEbEafjzSs2YapQH6mi8ke55zog88DXQpo5nIu9xYnc48xvSDP9mZM-PJxvSS3nz7eXn2ubr5df7n6cFNZLnmuEHvgPSjOe-VMu0O2hw4VSusUKiGlKP3wnRNG7hS0Rlrs9paJRjkBEtpL8ub07BLDjxVT1pNPFsex_CesSW-k6kTDeUHbE2pjSCniXi_RTyYeNQO9ydYH_Vu23mRrkLrILqnXjwXW3YTub-aP3QK8OwFYuvzpMepkixtbRMaiW7vg_1Pg_T95O_rZWzPe4xHTIaxxLgI106nRoL9v897GzTiAgqZtfwHrYah9</recordid><startdate>20141201</startdate><enddate>20141201</enddate><creator>Gonzalez, Maday, MD</creator><creator>Keating, Richard J., MD</creator><creator>Markowitz, Steven M., MD, FHRS</creator><creator>Liu, Christopher F., MD, FHRS</creator><creator>Thomas, George, MD</creator><creator>Ip, James E., MD, FHRS</creator><creator>Lerman, Bruce B., MD, FHRS</creator><creator>Cheung, Jim W., MD, FHRS</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4403-1330</orcidid></search><sort><creationdate>20141201</creationdate><title>Newly detected atrial high rate episodes predict long-term mortality outcomes in patients with permanent pacemakers</title><author>Gonzalez, Maday, MD ; Keating, Richard J., MD ; Markowitz, Steven M., MD, FHRS ; Liu, Christopher F., MD, FHRS ; Thomas, George, MD ; Ip, James E., MD, FHRS ; Lerman, Bruce B., MD, FHRS ; Cheung, Jim W., MD, FHRS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c484t-ee7047094479da3be1f05e9e8cd9e968860294bd6a8b903a8ce5fc1629d60803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis of Variance</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - mortality</topic><topic>Atrial Fibrillation - therapy</topic><topic>Cardiac Pacing, Artificial - adverse effects</topic><topic>Cardiac Pacing, Artificial - methods</topic><topic>Cardiovascular</topic><topic>Cause of Death</topic><topic>Cohort Studies</topic><topic>Electrocardiography - methods</topic><topic>Embolism - etiology</topic><topic>Embolism - mortality</topic><topic>Embolism - physiopathology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Pacemaker, Artificial</topic><topic>Permanent pacemaker</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Stroke - etiology</topic><topic>Stroke - mortality</topic><topic>Stroke - physiopathology</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gonzalez, Maday, MD</creatorcontrib><creatorcontrib>Keating, Richard J., MD</creatorcontrib><creatorcontrib>Markowitz, Steven M., MD, FHRS</creatorcontrib><creatorcontrib>Liu, Christopher F., MD, FHRS</creatorcontrib><creatorcontrib>Thomas, George, MD</creatorcontrib><creatorcontrib>Ip, James E., MD, FHRS</creatorcontrib><creatorcontrib>Lerman, Bruce B., MD, FHRS</creatorcontrib><creatorcontrib>Cheung, Jim W., MD, FHRS</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gonzalez, Maday, MD</au><au>Keating, Richard J., MD</au><au>Markowitz, Steven M., MD, FHRS</au><au>Liu, Christopher F., MD, FHRS</au><au>Thomas, George, MD</au><au>Ip, James E., MD, FHRS</au><au>Lerman, Bruce B., MD, FHRS</au><au>Cheung, Jim W., MD, FHRS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Newly detected atrial high rate episodes predict long-term mortality outcomes in patients with permanent pacemakers</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2014-12-01</date><risdate>2014</risdate><volume>11</volume><issue>12</issue><spage>2214</spage><epage>2221</epage><pages>2214-2221</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Background Subclinical atrial high rate episodes (AHREs) detected by implanted devices in patients with no history of atrial fibrillation (AF) have been associated with an increased risk of stroke and systemic embolism. Data regarding the long-term survival of patients with permanent pacemakers and newly detected AHREs are limited. Objective This study aimed to assess whether newly detected AHREs in pacemaker patients predict mortality outcomes. Methods We evaluated 224 patients (mean age 74 ± 12 years; 118 men [53%]) with no history of AF who underwent dual-chamber pacemaker implantation from 2002 through 2004. During follow-up, patients with AHREs of ≥5-minute duration were identified. Mortality data were obtained from the National Death Index. Results Thirty-nine patients (17%) had AHREs of ≥5-minute duration within 6 months of pacemaker implantation. Over a mean follow-up period of 6.6 ± 2.0 years, the rate of all-cause mortality was 29%. In multivariate analysis adjusted for age, sex, and cardiovascular diseases, AHREs were associated with a significant increase in cardiovascular mortality (hazard ratio [HR] 2.80; 95% confidence interval [CI] 1.24–6.31; P = .013) and stroke mortality (HR 9.65; 95% CI 1.56–59.9; P = .015), with a trend toward increased all-cause mortality (HR 1.79; 95% CI 0.98–3.26; P = .059). The subgroup of patients with AHREs of ≥5-minute but <1-day duration still had a significantly increased cardiovascular mortality (HR 3.24; 95% CI 1.37–7.66; P = .007). Conclusion AHREs are commonly encountered in pacemaker patients with no history of AF and are independent predictors of cardiovascular mortality.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25131667</pmid><doi>10.1016/j.hrthm.2014.08.019</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-4403-1330</orcidid></addata></record> |
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| subjects | Aged Aged, 80 and over Analysis of Variance Atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - mortality Atrial Fibrillation - therapy Cardiac Pacing, Artificial - adverse effects Cardiac Pacing, Artificial - methods Cardiovascular Cause of Death Cohort Studies Electrocardiography - methods Embolism - etiology Embolism - mortality Embolism - physiopathology Female Follow-Up Studies Humans Kaplan-Meier Estimate Male Middle Aged Mortality Multivariate Analysis Pacemaker, Artificial Permanent pacemaker Predictive Value of Tests Retrospective Studies Risk Assessment Severity of Illness Index Stroke - etiology Stroke - mortality Stroke - physiopathology Survival Analysis Time Factors Treatment Outcome |
| title | Newly detected atrial high rate episodes predict long-term mortality outcomes in patients with permanent pacemakers |
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