Background Current guidelines mainly address clinical atrial fibrillation and long Atrial Heart Rate Episodes (AHRE). This study focused on the clinical significance of incidental short AHRE detected by Cardiac Implantable Electronic Device (CIED).

Methods A single-centre retrospective observational study recruited patients from CIED clinic of Princess Margaret Hospital from 2015 to 2022, excluding patients with known clinical AF. The primary outcome was clinical AF and/or long AHRE more than 24 hours. Secondary outcomes included non-fatal stroke, admission for heart failure, myocardial infarction and death. AHRE+ vs AHRE- were compared using multivariate analysis, introducing AHRE duration as a time-dependent covariates. A receiver-operating characteristic (ROC) curve identified the optimal cut-off of AHRE duration with the most predictive value of primary outcome.

Results 310 patients were recruited with an average follow-up of 6 years. Short AHRE was the strongest independent predictor for primary outcome (adjHR 27.3). It was also an independent predictor for heart failure (adj HR 2.04), myocardial infarction or death (adjHR 1.74), and stroke or death (adjHR 1.60), adjusting for baseline characteristics. Anticoagulant use could be an independent preventive variable for stroke or death (adjHR 0.65). ROC analysis identified 16minutes as the optimal cut-off to predict primary outcome (Sen86%, Spe77%).

Conclusions The study demonstrated strong association of short AHRE with clinical AF or long AHRE. Short AHRE was also an independent predictor to adverse clinical outcomes. Anticoagulant use could have preventive effect for stroke or death.

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