Heart Rhythm · Mar 4, 2026

Association of atrial high-rate episodes daily burden with the risk of cardiovascular death, heart failure hospitalization, and stroke

By Botto GL, Pisanò ECL, Rapacciuolo A et al.

BACKGROUND: The clinical significance of device-detected atrial high-rate episodes (AHREs) is believed to increase with AHRE burden. OBJECTIVE: This study evaluated whether a daily burden ≥6 minutes is associated with major cardiovascular (CV) outcomes. METHODS: We analyzed 1160 patients with sinus node dysfunction and dual-chamber pacemakers or defibrillators from the B3 randomized trial, followed for 3 years. The primary composite end point included CV death, worsening heart failure hospitalization (WHFH), and stroke or transient ischemic attack (TIA). Secondary end points were individual components of the primary end point and progression to long-lasting AF. Using competing-risk survival models with AHRE burden as a time-varying covariate, we calculated CHA₂DS₂-VASc-adjusted hazard ratios (HRs) after the first day with burden ≥6 minutes. AHREs were all adjudicated. RESULTS: AHRE burden ≥6 minutes occurred in 52.5% of patients, 47.1% of whom had no prior AF. There were 65 primary events (10 CV deaths, 39 WHFHs, 16 strokes/TIAs). In patients without prior AF, AHRE burden ≥6 minutes was significantly associated with the primary end point (HR 4.9; 95% confidence interval [CI], 2.19-10.91; P < .001), and with CV death (P = .033), WHFH (P < .001), and long-lasting AF (P < .001), but not with stroke/TIA (P = .34). In contrast, no significant association was found in patients with prior AF (HR 0.83; 95% CI, 0.37-1.87; P = .65). CONCLUSION: In patients without prior AF, a daily AHRE burden ≥6 minutes was linked to a >4-fold increased risk of major CV events, mainly driven by CV death, WHFH, and progression to long-lasting AF. No such association was observed in patients with prior AF.

doi.org/10.1016/j.hrthm.2026.02.048PubMed 41791634Biomarkers