Background:An association between atrial high-rate episode (AHRE) and stroke has been reported, although data for the Asian population are limited. This study aimed to investigate the role of AHRE in ischemic and major bleeding events in patients who underwent a cardiac implantable electronic device (CIED) procedure.

Methods and Results:This single-center historical cohort study included 710 patients (age: 78±11 years, 374 women) who underwent a CIED-related procedure between October 2009 and September 2019 at Shimane Prefectural Central Hospital (median follow-up period: 4.5 [2.5, 7] years, 3439 person-years). Based on the maximum AHRE burden, patients were divided into: (1) <6 min; (2) ≥6 min to 24-h; and (3) ≥24-h groups. The cumulative incidence of ischemic (ischemic stroke, systemic embolism, and transient ischemic attack) and major bleeding (≥3 Bleeding Academic Research Consortium bleeding criteria) events after the procedure were compared. Uni- and multivariate analyses were performed to identify factors associated with these events. The incidence of both events increased with the rising AHRE burden, being significantly higher in the ≥24-h group than in the <6 min group. Multivariate analysis found age ≥85 years to be the only independent factor associated with both events.

Conclusions:Longer AHRE duration is associated with a high number of major bleeding and ischemic events. Monitoring these bleeding risks is mandatory when clinicians are considering anticoagulation therapy for such patients.

背景：尽管亚洲人群的数据有限，但已有报道称心房高频发作 (AHRE) 与中风之间存在关联。本研究旨在调查 AHRE 在接受心脏植入式电子设备 (CIED) 手术的患者的缺血性和大出血事件中的作用。

方法和结果：这项单中心历史队列研究包括 2009 年 10 月至 2019 年 9 月期间在岛根县立中心医院接受 CIED 相关手术的 710 名患者（年龄：78±11 岁，374 名女性）（中位随访时间：4.5 [2.5, 7]年，3439人年）。根据最大AHRE负担，将患者分为：（1）<6 min；(2)≥6分钟至24小时；(3) ≥24 小时组。比较了手术后缺血性（缺血性中风、全身性栓塞和短暂性脑缺血发作）和大出血（≥3 出血学术研究联盟出血标准）事件的累积发生率。进行单变量和多变量分析以确定与这些事件相关的因素。两种事件的发生率都随着 AHRE 负担的增加而增加，≥24 小时组显着高于 < 6分钟组。多变量分析发现年龄≥85 岁是与这两个事件相关的唯一独立因素。

结论：较长的 AHRE 持续时间与大量的大出血和缺血事件相关。当临床医生考虑对此类患者进行抗凝治疗时，必须监测这些出血风险。