The Predictive Value Of Atrial High-Rate Episodes After Pacemaker Implantation By C₂HEST Score

Background:Previous studies have found that atrial high-rate episodes（AHREs）after permanent pacemaker（PPM）implantation are increasingly common.Those who developed AHREs during follow-up had a significantly higher risk of clinical atrial fibrillation than those who did not.This group had a higher incidence of composite end-point events of all-cause mortality and hospitalization for heart failure,and the higher the AHREs load,the higher the risk of later stroke/transient ischemic attack（TIA）.Exploring clinical scores that can effectively predict the occurrence of AHREs after PPM implantation can help early detection of high-risk patients and guide the development of individualized clinical management strategies.Objective:Some studies have found that clinical scores used to assess the risk of new atrial fibrillation can be used to predict the development of AHREs.The purpose of this study was to explore the predictive value of C₂HEST,HAVOC,CHA₂DS₂-VASc scores and the optimal prediction model.Subjects:The subjects of this study were patients who received dual chamber PPM implantation in the Second Affiliated Hospital of Nanchang University from January 2018 to November 2020.Clinical data of patients meeting the criteria of inclusion and exclusion were collected.Preoperative C₂HEST,HAVOC,CHA₂DS₂-VASc scores were calculated.Pacemaker program-controlled data of all subjects were collected,and the date,duration and frequency of the first postoperative occurrence of AHREs were recorded.For patients with no AHREs recorded in the existing program-controlled data,the longest follow-up time was recorded.Statistical analysis was conducted to explore the risk factors affecting the occurrence of AHREs after dual chamber PPM implantation,and to compare the differences in the risk of AHREs with different C₂HEST scores and HAVOC scores.To compare the value of C₂HEST,HAVOC,CHA₂DS₂-VASc scores in predicting the occurrence of AHREs after dual chamber PPM implantation.Results:1.A total of 71 patients were included in the study,ranging in age from 28 to 83 years old at the time of first dual chamber PPM treatment,among whom 11.3% were aged ≥75 years.There were 34 males（47.9%）and 37 females（52.1%）.The median follow-up time was 8.0 months,and AHREs occurred in 8 patients（11.3%）.The median scores before dual chamber PPM implantation were C₂HEST score =1.0,HAVOC score =2.0 and CHA₂DS₂-VASc score =2.0,respectively.2.Compared with the group without AHREs,the age（70.0 vs.65.5,P=0.002）,the proportion of patients aged ≥ 75 years（62.5% vs.4.8%,P < 0.001）,the creatinine level（89.2 vs.78.3,P=0.036）and the right atrial diameter（37.5 vs.35.5,P=0.029）in the AHREs group were significantly higher.The proportion of patients with hypertension and coronary heart disease in this group was significantly higher than that in the group without AHREs（Hypertension: 100.0% vs.54.0%,P=0.018;Coronary heart disease: 62.5% vs.6.3%,P<0.001）.3.Multivariate Logistic regression analysis showed that the risk of developing AHREs after dual chamber PPM implantation increased with age（OR=1.260,95%CI（1.031,1.541）,P=0.024）.4.The preoperative C₂HEST score（2.0 vs.1.0,P<0.001）,HAVOC score（4.0 vs.0.0,P<0.001）and CHA₂DS₂-VASc score（3.0 vs.2.0,P=0.002）in the AHREs group were significantly higher than those in the group without AHREs.The risk of postoperative AHREs in high-risk group（≥4 points）with preoperative C₂HEST score was significantly higher than that in medium-risk group（2-3 points）and low-risk group（0-1 points）（Log-Rank test,P<0.001）.The higher the C₂HEST score,the higher the risk of postoperative AHREs（P for trend<0.001）.Patients with moderate HAVOC score（5-9）had a significantly higher risk of developing AHREs after dual chamber PPM implantation than those with low HAVOC score（0-4）（Log-Rank test,P<0.001）.5.The area under C₂HEST scoring curve（AUC）was 0.875（95%CI（0.732,1.017）,P<0.001）,and HAVOC scoring AUC was 0.873（95%CI（0.741,1.005）,P<0.001）.The AUC value of CHA₂DS₂-VASc score was 0.827（95%CI（0.730,0.925）,P<0.001）.All three scores had high predictive value for the occurrence of AHREs after dual chamber PPM implantation,and there was no significant difference in the predictive value among them（C2HEST score vs.HAVOC score,P=0.894;C2HEST score vs.CHA₂DS₂-VASc score,P=0.613;HAVOC Score vs.CHA₂DS₂-VASc score,P=0.606）.Conclusion:1.Age is an independent risk factor for AHREs after dual chamber PPM implantation.2.C₂HEST score can be used to predict the occurrence of AHREs after dual chamber PPM implantation,and the higher the C₂HEST score,the higher the risk of postoperative AHREs.3.C₂HEST score,HAVOC score,and CHA₂DS₂-VASc score were equally valuable in predicting the occurrence of AHREs after dual chamber PPM implantation.