Dual-chamber paced patients without high-degree AV block at baseline are at higher risk of atrial arrhythmias when inappropriately paced in the right ventricle: a sub-analysis of the EMERALD study
Notice bibliographique
Résumé
Abstract Background/Introduction Unnecessary right ventricular pacing (RVP) can have deleterious effects including an increased risk of atrial arrhythmia (AA) and heart failure during follow-up (FU) in dual-chamber (DR) paced patients. While previous studies have shown that these increased risks occur with RVP>40%, the EMERALD Study demonstrated an increased risk for RVP>1%. Few data exist on the interaction between the amount of RVP and the presence/absence of high-degree atrio-ventricular block (AVB) as a pacing indication at baseline. Purpose The EMERALD (AssEssment of CoMorbiditiEs & Atrial ArRhythmiA Burden In DuaL-Chamber PaceD Patients) Study was a real-world registry designed to assess the impact of RVP burden on the risk of developing persistent/permanent AA (Pers-AA) over 2-year FU. The primary endpoint was the difference in Pers-AA in subjects with high (>40%) and low (<40%) RVP. This sub-analysis aimed to identify the interaction between RVP and the presence/absence of high-degree AVB at baseline in relation to the incidence of Pers-AA. Methods EMERALD was a non-interventional, prospective, multi-center registry conducted at 186 centers in 12 countries. Enrolled subjects were implanted with a DR pacemaker according to ESC or ACC/AHA/HRS guidelines. Subjects were excluded if they had a history of Pers-AA. Devices could be implanted as de-novo, replacement or upgrade therapy. Programming was left to the investigators' discretion. Subjects were followed for at least 24 months. Pers-AA was defined as: >22 h/day of AA for >7 consecutive days; Pers-AA diagnosed during any FU visit; AA-related ablation or cardioversion carried out in the FU period. We compared the incidence of Pers-AA between subjects with (n=1529) and without (n=1948) high-degree AVB as a baseline pacing indication. Results Eligible FU data were available for n=3477 subjects. The overall population was nearly evenly split - High RVP (47.7%) and Low RVP (52.3%). In the High RVP group, 11.7% experienced at least one Pers-AA episode versus 9.1% in the Low RVP group (p=0.006). In this sub-analysis, the prevalence of RVP>40% was higher in patients with high-degree AVB at baseline (74% vs 26%). Although the incidence of Pers-AA was similar in the group with high-degree AVB at baseline (High RVP 8.7% vs Low RVP 7.4%), in the group without high-degree AVB at baseline, those with High RVP developed a significantly higher incidence of Pers-AA (High RVP 18.2% vs Low RVP 9.5%, p value for interaction 0.0275; Figure 1). An analysis with a newly identified RVP threshold of 1% confirmed a high incidence of Pers-AA only in the group without high-degree AVB at baseline (18% vs 3.5%, p value for interaction 0.2265; Figure 2). Conclusions The baseline pacing indication sub-analysis of the EMERALD Study shows that patients without high-degree AVB as a baseline indication are at highest risk of Pers-AA. Efforts should be made to avoid any unnecessary RVP in this subgroup of patients. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): MicroPort CRM (Clamart, France)
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».