Multimodality imaging assessment of the Biatrial remodeling of the burden of atrial high-rate episodes in patients with cardiac implanted electronic devices

The underlying mechanisms of atrial remodeling in cardiac implanted electronic device(CIED)-detected atrial high-rate episodes(AHRE) remains to be elucidated. A cardiac computed tomography and a strain echocardiography were performed to delineate the structural and functional characteristics of both atria. Biatrial volumes, emptying fraction(EF) and peak atrial longitudinal/contractile strain(PALS/PACS) were evaluated. All AHRE were analyzed. A total of 80 CIED patients with AHRE were categorized by AHRE duration into 3 groups: Group 1: 6 h(n = 15). Left atrial(LA) maximal volume(Vmax), atrial precontraction volume(Vapc), minimal volume(Vmin), LAEF, and PALS/PACS were all increasingly worsened among the patients in the 3 groups (p value for trend 6 h. These LA structural and functional may be considered surrogate imaging markers for stroke risk assessment in patients with CHA2DS2-VASc ≥2 and AHRE. [Display omitted] •Functional remodeling of the atria manifested as reduced strain after atrial high-rate episode (AHRE) >6 min.•Increased biatrial volumes and decreased left atrial (LA) reservoir/pump function occurred when AHRE were >6 h.•No obvious LA volume differences occurred when comparing the group of AHRE