scholarly journals HATCH Score and Left Atrial Size Predict Atrial High-Rate Episodes in Patients With Cardiac Implantable Electronic Devices

2021 ◽  
Vol 8 ◽  
Author(s):  
Ju-Yi Chen ◽  
Tse-Wei Chen ◽  
Wei-Da Lu
Keyword(s):  
Left Atrial ◽  
Electronic Devices ◽  
High Rate ◽  
Youden Index ◽  
Left Atrial Diameter ◽  
Cardiac Implantable Electronic Devices ◽  
Cerebrovascular Events ◽  
Atrial Size ◽  
Increased Risk ◽  
Time Dependent Covariates

Background: Patients with sustained atrial high-rate episodes (AHRE) have a high risk of major adverse cardio/cerebrovascular events (MACCE). However, the prediction model and factors for the occurrence of AHRE are unknown. We aimed to identify independent factors and various risk models for predicting MACCE and AHRE.Methods: We retrospectively enrolled 314 consecutive patients who had cardiac implantable electronic devices (CIEDs). The primary endpoint was MACCE after AHRE ≥3, 6 min, and 6 h. Atrial high-rate episodes was defined as >175 bpm (Medtronic®) lasting ≥30 s. Multivariate Cox and logistic regression analysis with time-dependent covariates were used to determine variables associated with independent risk of MACCE and occurrence of AHRE ≥3 min, respectively.Results: One hundred twenty-five patients (39.8%) developed AHRE ≥3 min, 103 (32.8%) ≥6 min, and 55 (17.5%) ≥6 h. During follow-up (median 32 months), 77 MACCE occurred (incidence 9.20/100 patient years, 95% CI 5.66–18.39). The optimal AHRE cutoff value was 3 min for MACCE, with highest Youden index 1.350 (AUC, 0.716; 95% CI, 0.638–0.793; p < 0.001). Atrial high-rate episodes ≥3 min−6 h were independently associated with MACCE. HATCH score and left atrial diameter were independently associated with AHRE ≥3 min. The optimal cutoff for HATCH score was 3 and for left atrial diameter was 4 cm for AHRE ≥3 min.Conclusion: Patients with CIEDs who develop AHRE ≥3 min have an independently increased risk of MACCE. Comprehensive assessment using HATCH score and echocardiography of patients with CIEDs is warranted.

scholarly journals Atrial high-rate episodes predict major adverse cardio/cerebrovascular events in patients with cardiac implantable electrical devices

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ju-Yi Chen ◽  
Tse-Wei Chen ◽  
Wei-Da Lu
Keyword(s):  
Cox Regression ◽  
High Rate ◽  
Youden Index ◽  
Cox Regression Analysis ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Electrical Devices ◽  
Time Dependent Covariates ◽  
Cutoff Threshold

AbstractPatients with atrial high-rate episodes (AHRE) have a high risk of neurologic events, although the causal role and optimal cutoff threshold of AHRE for major adverse cardio/cerebrovascular events (MACCE) are unknown. This study aimed to identify independent factors for AHRE and subsequent atrial fibrillation (AF) after documented AHRE. We enrolled 470 consecutive patients undergoing cardiac implantable electrical device (CIED) implantations. The primary endpoint was subsequent MACCE after AHRE ≥ 6 min, 6 h, and 24 h. AHRE was defined as > 175 beats per minute (bpm) (Medtronic®) or > 200 bpm (Biotronik®) lasting ≥ 30 s. Multivariate Cox regression analysis with time-dependent covariates was used to determine variables associated with independent risk of MACCE. The patients’ median age was 76 year, and 126 patients (26.8%) developed AHRE ≥ 6 min, 63 (13.4%) ≥ 6 h, and 39 (8.3%) ≥ 24 h. During follow-up (median: 29 months), 142 MACCE occurred in 123 patients. Optimal AHRE cutoff value was 6 min, with highest Youden index for MACCE. AHRE ≥ 6 min ~ 24 h was independently associated with MACCE and predicted subsequent AF. Male gender, lower body mass index, or BMI, and left atrial diameter were independently associated with AHRE ≥ 6 min ~ 24 h. Patients with CIEDs who develop AHRE ≥ 6 min have an independently increased risk of MACCE. Comprehensive assessment of patients with CIEDs is warranted.

scholarly journals Subclinical Atrial Fibrillation and Risk of Stroke: Past, Present and Future

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 611 ◽  
Author(s):  
AlTurki ◽  
Marafi ◽  
Russo ◽  
Proietti ◽  
Essebag
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Electronic Devices ◽  
High Rate ◽  
Cardiac Monitoring ◽  
Stroke Event ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk ◽  
History Of ◽  
New Evidence

Subclinical atrial fibrillation (SCAF) describes asymptomatic episodes of atrial fibrillation (AF) that are detected by cardiac implantable electronic devices (CIED). The increased utilization of CIEDs renders our understanding of SCAF important to clinical practice. Furthermore, 20% of AF present initially as a stroke event and prolonged cardiac monitoring of stroke patients is likely to uncover a significant prevalence of SCAF. New evidence has shown that implanting cardiac monitors into patients with no history of atrial fibrillation but with risk factors for stroke will yield an incidence of SCAF approaching 30–40% at around three years. Atrial high rate episodes lasting longer than five minutes are likely to represent SCAF. SCAF has been associated with an increased risk of stroke that is particularly significant when episodes of SCAF are greater than 23 hours in duration. Longer episodes of SCAF are incrementally more likely to progress to episodes of SCAF >23 hours as time progresses. While only around 30–40% of SCAF events are temporally related to stroke events, the presence of SCAF likely represents an important risk marker for stroke. Ongoing trials of anticoagulation in patients with SCAF durations less than 24 hours will inform clinical practice and are highly anticipated. Further studies are needed to clarify the association between SCAF and clinical outcomes as well as the factors that modify this association.

scholarly journals HAT2CH2 Score Predicts Systemic Thromboembolic Events in Elderly After Cardiac Electronic Device Implantation

2021 ◽  
Vol 8 ◽  
Author(s):  
Ju-Yi Chen ◽  
Tse-Wei Chen ◽  
Wei-Da Lu
Keyword(s):  
Regression Analysis ◽  
Older Patients ◽  
Cox Regression ◽  
Electronic Device ◽  
High Rate ◽  
Youden Index ◽  
Thromboembolic Events ◽  
Cox Regression Analysis ◽  
Cardiac Implantable Electronic Devices ◽  
Time Dependent Covariates

Background: The HAT2CH2 score has been evaluated for predicting new onset atrial fibrillation, but never for adverse systemic thromboembolic events (STE) in elderly. We aimed to evaluate the HAT2CH2 score and comparing to atrial high rate episodes (AHRE) ≥24 h for predicting STE in older patients with cardiac implantable electronic devices (CIED) implantation.Methods: We retrospective enrolled 219 consecutive patients ≥ 65 years of age undergoing CIED implantation. The primary endpoint was subsequent STE. For all patients in the cohort, the CHA2DS2-VASc, C2HEST, mC2HEST, HAVOC, HAT2CH2 scores and AHRE ≥ 24 h were determined. AHRE was defined as > 175 bpm lasting ≥ 30 s. Multivariate Cox regression analysis with time-dependent covariates was used to determine variables associated with independent risk of STE.Results: The median patient age was 77 years, and 61.2% of the cohort was male. During follow-up (median, 35 months), 16 STE occurred (incidence rate, 2.51/100 patient-years; 95% CI, 1.65–5.48). Multiple Cox regression analysis showed that the HAT2CH2 score (HR, 3.405; 95% CI, 2.272–5.104; p < 0.001) was an independent predictor for STE. The optimal HAT2CH2 score cutoff value was 3, with the highest Youden index (AUC, 0.907; 95% CI, 0.853–0.962; p < 0.001). The STE rate increased with increasing HAT2CH2 score (p < 0.001).Conclusions: This study is the first to show the prognostic value of the HAT2CH2 score for STE occurrence in older patients with CIEDs.

scholarly journals Identifying At‐Risk Patients for Sustained Atrial High‐Rate Episodes Using the C 2 HEST Score: The West Birmingham Atrial Fibrillation Project

2021 ◽  
Vol 10 (6) ◽  
Author(s):  
Yan‐Guang Li ◽  
Daniele Pastori ◽  
Kazuo Miyazawa ◽  
Farhan Shahid ◽  
Gregory Y. H. Lip
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Electronic Device ◽  
Electronic Devices ◽  
Systolic Heart Failure ◽  
High Rate ◽  
Cardiac Implantable Electronic Device ◽  
The West ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk

Background Sustained atrial high‐rate episodes (SAHREs) among individuals with a cardiac implantable electronic device are associated with an increased risk of adverse outcomes. Risk stratification for the development of SAHREs has never been investigated. We aimed to assess the performance of the C 2 HEST (coronary artery disease or chronic obstructive pulmonary disease [1 point each], hypertension [1 point], elderly [age ≥75 years, 2 points], systolic heart failure [2 points], thyroid disease [1 point]) score in predicting SAHREs in patients with cardiac implantable electronic devices without atrial fibrillation. Methods and Results Five Hundred consecutive patients with cardiac implantable electronic devices in the West Birmingham Atrial Fibrillation Project in the United Kingdom were followed since the procedure to observe the development of SAHREs, defined by atrial high‐rate episodes lasting >24 hours. Risk factors and incidence of SAHREs were analyzed. The predictive value of the C 2 HEST score for SAHRE prediction was evaluated. Over a mean follow‐up of 53.1 months, 44 (8.8%) patients developed SAHREs. SAHREs were associated with higher all‐cause mortality ( P <0.001) and ischemic stroke ( P =0.001). Age and heart failure were associated with SAHRE occurrence. The incidence of SAHREs increased by the C 2 HEST score (39% higher risk per point increase). Among patients with a C 2 HEST score ≥4, the incidence of SAHREs was 3.62% per year (95% CI, 2.14–5.16). The C 2 HEST score had moderate predictive capability (area under the curve, 0.73; 95% CI, 0.64–0.81) and discriminative ability (log‐rank P =0.003), which was better than other clinical scores (CHA 2 DS 2 ‐VASc, CHADS 2 , HATCH). Conclusions The C 2 HEST score predicted SAHRE incidence in patients without atrial fibrillation who had an cardiac implantable electronic device, with the highest risk seen in patients with a C 2 HEST score ≥4 The benefit of using the C 2 HEST score in clinical practice in this patient population needs further investigation.

scholarly journals Silent ischaemic brain lesions related to atrial high rate episodes in patients with cardiac implantable electronic devices

EP Europace ◽  
2014 ◽  
Vol 17 (3) ◽  
pp. 364-369 ◽  
Author(s):  
J. Benezet-Mazuecos ◽  
J. M. Rubio ◽  
M. Cortes ◽  
J. A. Iglesias ◽  
S. Calle ◽  
...  
Keyword(s):  
Electronic Devices ◽  
Brain Lesions ◽  
High Rate ◽  
Cardiac Implantable Electronic Devices ◽  
Ischaemic Brain

scholarly journals Protecting the most vulnerable during COVID-19 and beyond: a case report on the remote management of heart failure patients with cardiac implantable electronic devices

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6
Author(s):  
Fozia Zahir Ahmed ◽  
Carol Crosbie ◽  
Matthew Kahn ◽  
Manish Motwani
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Electronic Devices ◽  
Management Strategies ◽  
Phone Call ◽  
Cardiac Resynchronization ◽  
Physiological Data ◽  
Related Data ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk

Abstract Background Heart failure (HF) patients with cardiac implantable electronic devices (CIEDs) represent an important cohort. They are at increased risk of hospitalization and mortality. We outline how remote-only management strategies, which leverage transmitted health-related data, can be used to optimize care for HF patients with a CIED during the COVID-19 pandemic. Case summary An 82-year-old man with HF, stable on medical therapy, underwent cardiac resynchronization therapy implantation in 2016. Modern CIEDs facilitate remote monitoring by providing real-time physiological data (thoracic impedance, heart rate and rhythm, etc.). The ‘Triage Heart Failure Risk Score’ (Triage-HFRS), available on Medtronic CIEDs, integrates several monitored physiological parameters into a risk prediction model classifying patients as low, medium, or high risk of HF events within 30 days. In November 2019, the patient was enrolled in an innovative clinical pathway (Triage-HF Plus) whereby any ‘high’ Triage-HF risk status transmission prompts a phone call-based virtual consultation. A high-risk alert was received via remote transmission on 11 March, triggering a phone call assessment. Upon reporting increasing breathlessness, diuretics were initiated. The prescription was remotely issued and delivered to the patient’s home. This approach circumvented the need for all face-to-face reviews, delivering care in an entirely remote manner. Discussion The challenges posed by COVID-19 have prompted us to think differently about how we deliver care for patients, both now and following the pandemic. Contemporary CIEDs facilitate the ability to remotely monitor HF patients by providing rich physiological data that can help identify individuals at elevated risk of decompensation using automated device-generated alerts.

scholarly journals Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association

Circulation ◽  
2019 ◽  
Vol 140 (25) ◽  
Author(s):  
Peter A. Noseworthy ◽  
Elizabeth S. Kaufman ◽  
Lin Y. Chen ◽  
Mina K. Chung ◽  
Mitchell S.V. Elkind ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
American Heart ◽  
Electronic Devices ◽  
Heart Association ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk ◽  
Scientific Statement ◽  
Existing Data

The widespread use of cardiac implantable electronic devices and wearable monitors has led to the detection of subclinical atrial fibrillation in a substantial proportion of patients. There is evidence that these asymptomatic arrhythmias are associated with increased risk of stroke. Thus, detection of subclinical atrial fibrillation may offer an opportunity to reduce stroke risk by initiating anticoagulation. However, it is unknown whether long-term anticoagulation is warranted and in what populations. This scientific statement explores the existing data on the prevalence, clinical significance, and management of subclinical atrial fibrillation and identifies current gaps in knowledge and areas of controversy and consensus.

Abstract 16842: Cost-Effectiveness of Antibiotic-Eluting Envelopes for Prevention of Infections Associated With Cardiac Implantable Electronic Devices

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ronuk Modi ◽  
Peter Zimetbaum ◽  
Nicolas Isaza ◽  
Paola Calvachi ◽  
Inbar Raber ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Healthcare Costs ◽  
Electronic Devices ◽  
Sensitivity Analyses ◽  
Healthcare Sector ◽  
Term Survival ◽  
Cardiac Implantable Electronic Devices ◽  
Life Years ◽  
Increased Risk

Introduction: Infections of cardiac implantable electronic devices result in substantial morbidity and healthcare costs. Using an antibiotic-eluting envelope (AEE) during implantation may reduce the incidence of device-related infection. We examined the cost-effectiveness of an AEE in patients receiving CRT-D devices. Methods: This analysis was conducted independent of the trial sponsor. We developed a state-transition Markov model to compare the use of an AEE with usual care during CRT-D initial implantation or reimplantation. Effectiveness of the AEE (unit cost $1000) was estimated from the Worldwide Randomized Antibiotic Envelope Infection Prevention Trial. Other inputs were derived from prior trials, registries, vital statistics, and nationally representative datasets. Long-term survival was projected using a non-parametric approach. The model reported incidence of infections, mortality, quality-adjusted life years (QALYs), and direct healthcare costs. Future costs and QALYs were discounted by 3% annually. The primary outcome was the incremental cost-effectiveness ratio (ICER) of AEE use from the US healthcare sector perspective over a lifetime analytic horizon. We assumed a cost-effectiveness threshold of $100,000 per QALY gained. Results: Use of an AEE at initial CRT-D implantation added 0.008 QALYs per patient at an incremental cost of $918 (ICER $118,000/QALY). Due to higher infection rates, the use of AEE in reimplantation procedures was more economically attractive (ICER $55,900/QALY). One-way sensitivity analyses showed an inverse relationship between ICER and rate of infection. The ICER was less than $100,000/QALY with infection rate greater than 2.42% in the first year after new CRT-D (Figure 1). Conclusions: At current prices, use of AEE is cost-effective for CRT-D reimplantation procedures but not for initial CRT-D implants. Cost-effectiveness of AEEs may be improved by restricting use to patients at increased risk of infection.

Sign in / Sign up

Export Citation Format

Share Document