title: Newly detected atrial high rate episodes predict long-term mortality outcomes in patients with permanent pacemakers.
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).
  
  
  CONCLUSIONS
  AHREs are commonly encountered in pacemaker patients with no history of AF and are independent predictors of cardiovascular mortality.
authors.affiliation: Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: Maday
authors.initials: M
authors.lastname: Gonzalez
authors.affiliation: Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Keating
authors.affiliation: Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Markowitz
authors.affiliation: Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Liu
authors.affiliation: Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: George
authors.initials: G
authors.lastname: Thomas
authors.affiliation: Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: James E
authors.initials: JE
authors.lastname: Ip
authors.affiliation: Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Lerman
authors.affiliation: Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, New York. Electronic address: jac9029@med.cornell.edu.
authors.forename: Jim W
authors.initials: JW
authors.lastname: Cheung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D002423:Cause of Death; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods; D004617:Embolism / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Mortality; Permanent pacemaker