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...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.022487 |
| _version_ | 1811206323586465792 |
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| 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 |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-12T03:45:24Z |
| format | Article |
| id | doaj.art-b03e3f71d65646eca2df286a8ae14a04 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-12T03:45:24Z |
| publishDate | 2021-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-b03e3f71d65646eca2df286a8ae14a042022-12-22T03:49:08ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-11-01102210.1161/JAHA.121.022487Atrial High‐Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta‐AnalysisDimitrios Sagris0Georgios Georgiopoulos1Konstantinos Pateras2Kalliopi Perlepe3Eleni Korompoki4Haralampos Milionis5Dimitrios Tsiachris6Cheuk Chan7Gregory Y. H. Lip8George Ntaios9Department of Internal Medicine School of Health Sciences Faculty of Medicine University of Thessaly Larissa GreeceSchool of Biomedical Engineering and Imaging Sciences King's College London United KingdomDepartment of Biostatistics and Research Support Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht the NetherlandsDepartment of Internal Medicine School of Health Sciences Faculty of Medicine University of Thessaly Larissa GreeceDepartment of Clinical Therapeutics National and Kapodistrian University of Athens Athens GreeceDepartment of Internal Medicine University Hospital of Ioannina Ioannina GreeceAthens Heart Center Athens Medical Center Athens GreeceSchool of Biomedical Engineering and Imaging Sciences King's College London United KingdomLiverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart and Chest Hospital Liverpool United KingdomDepartment of Internal Medicine School of Health Sciences Faculty of Medicine University of Thessaly Larissa GreeceBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.121.022487atrial high‐rate episodeembolismimplantable devicestroke |
| spellingShingle | 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 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial high‐rate episode embolism implantable device stroke |
| title | 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_short | 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 |
| topic | atrial high‐rate episode embolism implantable device stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.022487 |
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