Impact of HFpEF on Atrial High-Rate Episodes Incidence and Predictive Factors

Abstract

Introduction: HFpEF, linked to increased atrial tachycardia events, poses significant treatment challenges. Cardiac implantable devices allow early AHRE detection, crucial in refining HFpEF patient treatment and enhancing outcomes. Objectives: Assess Atrial High-Rate Events (AHREs) incidence post-pacemaker implantation and predictors in patients with/without Heart Failure with Preserved ejection Fraction (HFpEF). Methods: Single-center, retrospective study of 300 patients who implanted a pacemaker between January and November 2021. Follow-up period was 14 months. Exclusion criteria were prior atrial tachyarrhythmias, single chamber pacemakers, reduced/mid-range ejection fraction heart failure, and 15-day post-implant mortality. Final cohort of 123 patients were categorized into HFpEF and non-HF. Primary outcome was time to first AHRE. A univariate and multivariate Cox-regression model was used to determine predictors of AHREs. A survival analysis was applied using the Kaplan-Meier method. Results: Of 123 patients, 71 (58%) had no HF and 52 (42%) had HFpEF. No mortality was reported. The HFpEF group was older (84 vs. 78 years, p=0.006), had increased use of anticoagulants (p<0.001) and vasodilators (p=0.035), larger left atrium (p<0.001), and lower LVEF (57.0% vs. 59.0%, p=0.043). AHRE incidence was higher in HFpEF (25.04 vs. 4.18 per 1000 patient-months). Time to first event was shorter in the HFpEF group (p<0.001). Univariate and multivariate analysis identified HFpEF as a significant predictor (HR 5.73, CI: 2.57-12.78, p<0.001; HR 4.37, CI: 1.74-11.0, p=0.002). Conclusion: HFpEF is an independent AHRE predictor, with higher incidence and earlier occurrence in these patients. Findings emphasize the need for specific monitoring and management to improve outcomes in HFpEF patients.