Long duration of atrial high-rate episode is more favorable in predicting ischemic stroke than high CHA2DS2-VASc score

Objective: This study aimed to explore the roles of duration and burden of atrial high-rate episode (AHRE) on ischemic stroke in patients with pacemaker implantation.Methods: Patients with pacemaker implantation for bradycardia from 2013 to 2017 were consecutively enrolled. Data such as gender, age, combined diseases, type of AF, left atrial size, left ventricular size, left ventricular ejection fraction, CHA(2)DS(2)-VASc score, and anticoagulants were collected. The burden and duration of AHRE based on different interval partition were also recorded in detail to evaluate the impacts on ischemic stroke. Cox regression analysis with time-dependent covariates was conducted.Results: A total of 220 patients with AHRE were enrolled. The average follow-up time was 48.42 +/- 17.20 months. Univariate regression analysis showed that diabetes (p = .024), high CHA(2)DS(2)-VASc score (>= 2) (p = .021), long mean AHRE burden (p = .011), long maximal AHRE burden (p = .015), long AHRE duration lasting >= 48 h (p = .001) or 24 h (p = .001) or 12 h (p = .005) were prone to ischemic stroke. Further multivariate regression analysis showed that long duration of AHRE (>= 48 h) (HR 10.77; 95% CI 3.22-55.12; p = .030) were significantly correlated with stroke in patients with paroxysmal AF. There was no significant correlation between the type of AF and stroke (p = .927).Conclusion: The longer duration of AHRE (>= 48 h) was more favorable in predicting ischemic stroke than high CHA(2)DS(2)-VASc score (>= 2).