Atrial High‐Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta‐Analysis

Background Available evidence supports an association between atrial high‐rate episode (AHRE) burden and thromboembolic risk, but the necessary extent and duration of AHREs to increase the thromboembolic risk remain to be defined. The aim of this systematic review and meta‐analysis was to identify t...

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Autores principales:	Dimitrios Sagris, Georgios Georgiopoulos, Konstantinos Pateras, Kalliopi Perlepe, Eleni Korompoki, Haralampos Milionis, Dimitrios Tsiachris, Cheuk Chan, Gregory Y. H. Lip, George Ntaios
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	atrial high‐rate episode embolism implantable device stroke Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/b03e3f71d65646eca2df286a8ae14a04
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spelling	oai:doaj.org-article:b03e3f71d65646eca2df286a8ae14a042021-11-16T10:22:43ZAtrial High‐Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta‐Analysis10.1161/JAHA.121.0224872047-9980https://doaj.org/article/b03e3f71d65646eca2df286a8ae14a042021-11-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.022487https://doaj.org/toc/2047-9980Background Available evidence supports an association between atrial high‐rate episode (AHRE) burden and thromboembolic risk, but the necessary extent and duration of AHREs to increase the thromboembolic risk remain to be defined. The aim of this systematic review and meta‐analysis was to identify the thromboembolic risk associated with various AHRE thresholds. Methods and Results We searched PubMed and Scopus until January 9, 2020, for literature reporting AHRE duration and thromboembolic risk in patients with implantable electronic devices. The outcome assessed was stroke or systemic embolism. Risk estimates were reported as hazard ratio (HR) or relative risk alongside 95% CIs. We used the Paule‐Mandel estimator, and heterogeneity was calculated with I2 index. Among 27 studies including 61 919 patients, 23 studies reported rates according to the duration of the longest AHRE and 4 studies reported rates according to the cumulative day‐level AHRE duration. In patients with cardiac implantable devices, AHREs lasting ≥30 seconds significantly increased the risk of stroke or systemic embolism (HR, 4.41; 95% CI, 2.32–8.39; I2, 5.5%), which remained consistent for the thresholds of 5 minutes and 6 and 24 hours. Patients with previous stroke or transient ischemic attack and AHREs lasting ≥2 minutes had a marginally increased risk of recurrent stroke or transient ischemic attack. The risk of stroke or systemic embolism was higher in patients with cumulative AHRE ≥24 hours compared with those of shorter duration or no AHRE (HR, 1.25; 95% CI, 1.04–1.52; I2, 0%). Conclusions This systematic review and meta‐analysis suggests that single AHRE episodes ≥30 seconds and cumulative AHRE duration ≥24 hours are associated with increased risk of stroke or systemic embolism.Dimitrios SagrisGeorgios GeorgiopoulosKonstantinos PaterasKalliopi PerlepeEleni KorompokiHaralampos MilionisDimitrios TsiachrisCheuk ChanGregory Y. H. LipGeorge NtaiosWileyarticleatrial high‐rate episodeembolismimplantable devicestrokeDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 22 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial high‐rate episode embolism implantable device stroke Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	atrial high‐rate episode embolism implantable device stroke Diseases of the circulatory (Cardiovascular) system RC666-701 Dimitrios Sagris Georgios Georgiopoulos Konstantinos Pateras Kalliopi Perlepe Eleni Korompoki Haralampos Milionis Dimitrios Tsiachris Cheuk Chan Gregory Y. H. Lip George Ntaios Atrial High‐Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta‐Analysis
description	Background Available evidence supports an association between atrial high‐rate episode (AHRE) burden and thromboembolic risk, but the necessary extent and duration of AHREs to increase the thromboembolic risk remain to be defined. The aim of this systematic review and meta‐analysis was to identify the thromboembolic risk associated with various AHRE thresholds. Methods and Results We searched PubMed and Scopus until January 9, 2020, for literature reporting AHRE duration and thromboembolic risk in patients with implantable electronic devices. The outcome assessed was stroke or systemic embolism. Risk estimates were reported as hazard ratio (HR) or relative risk alongside 95% CIs. We used the Paule‐Mandel estimator, and heterogeneity was calculated with I2 index. Among 27 studies including 61 919 patients, 23 studies reported rates according to the duration of the longest AHRE and 4 studies reported rates according to the cumulative day‐level AHRE duration. In patients with cardiac implantable devices, AHREs lasting ≥30 seconds significantly increased the risk of stroke or systemic embolism (HR, 4.41; 95% CI, 2.32–8.39; I2, 5.5%), which remained consistent for the thresholds of 5 minutes and 6 and 24 hours. Patients with previous stroke or transient ischemic attack and AHREs lasting ≥2 minutes had a marginally increased risk of recurrent stroke or transient ischemic attack. The risk of stroke or systemic embolism was higher in patients with cumulative AHRE ≥24 hours compared with those of shorter duration or no AHRE (HR, 1.25; 95% CI, 1.04–1.52; I2, 0%). Conclusions This systematic review and meta‐analysis suggests that single AHRE episodes ≥30 seconds and cumulative AHRE duration ≥24 hours are associated with increased risk of stroke or systemic embolism.
format	article
author	Dimitrios Sagris Georgios Georgiopoulos Konstantinos Pateras Kalliopi Perlepe Eleni Korompoki Haralampos Milionis Dimitrios Tsiachris Cheuk Chan Gregory Y. H. Lip George Ntaios
author_facet	Dimitrios Sagris Georgios Georgiopoulos Konstantinos Pateras Kalliopi Perlepe Eleni Korompoki Haralampos Milionis Dimitrios Tsiachris Cheuk Chan Gregory Y. H. Lip George Ntaios
author_sort	Dimitrios Sagris
title	Atrial High‐Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta‐Analysis
title_short	Atrial High‐Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta‐Analysis
title_full	Atrial High‐Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta‐Analysis
title_fullStr	Atrial High‐Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta‐Analysis
title_full_unstemmed	Atrial High‐Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta‐Analysis
title_sort	atrial high‐rate episode duration thresholds and thromboembolic risk: a systematic review and meta‐analysis
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/b03e3f71d65646eca2df286a8ae14a04
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Atrial High‐Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta‐Analysis

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