Left Ventricular Mass Index and Relative Wall Thickness Predict Atrial High-Rate Episodes in Patients With Pacemaker Implantation.

BACKGROUND

Previous studies have shown that atrial high-rate episodes (AHREs) after cardiac device implantation are associated with the occurrence of stroke. This study aimed to explore the predictive value of echocardiographic indices, namely left ventricular mass index (LVMI) and relative wall thickness (RWT), for AHREs following implantation of a cardiac implantable electronic device (CIED).

METHODS

This was a single-center retrospective study. Patients who underwent initial dual-chamber permanent pacemaker implantation at the Fifth Affiliated Hospital of Sun Yat-sen University from January 1, 2020 to March 30, 2025, were included. Routine postoperative pacemaker programming was performed, and the occurrence of AHREs was set as the study endpoint. Based on whether AHREs were recorded in pacemaker programming, patients were divided into the AHREs group and non-AHREs group. Clinical baseline data, serological indicators, and echocardiographic indices were compared between the two groups. Spearman correlation analysis was used to evaluate the correlations between echocardiographic indices and permanent pacemaker implantation parameters (pacemaker threshold, pacemaker sensing, atrial output voltage). Cox regression analysis was conducted to identify independent predictors of AHREs. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of these indices for AHREs. Additionally, Kaplan-Meier survival analysis was used to compare the cumulative incidence of AHREs among groups with different levels of RWT and LVMI.

RESULTS

A total of 122 patients were included, and 45 patients developed AHREs during the follow-up period. Early diastolic mitral inflow E-wave velocity (r = 0.297, p < 0.001) and right atrial parameters (r = 0.280, p = 0.002) were positively correlated with pacemaker sensing parameters, with statistically significant yet weak correlations. Univariate Cox regression analysis revealed significant correlations between the occurrence of AHREs and early diastolic tricuspid inflow E-wave velocity, fractional shortening (FS), RWT, diastolic wall strain (DWS), LVMI, and type of cardiac remodeling (all p < 0.05). Multivariate Cox regression analysis demonstrated that lower RWT (B = -7.576, p = 0.007) and higher LVMI (B = 0.013, p = 0.003) were associated with an increased risk of AHREs. ROC curve analysis showed that the area under the curve (AUC) of LVMI and RWT for predicting AHREs were 0.722 and 0.716, respectively. Kaplan-Meier survival analysis indicated that patients with LVMI  ≥ 114.930 or RWT < 0.392 had a higher incidence of AHREs within 5 years after dual-chamber permanent pacemaker implantation.

CONCLUSION

In our study, echocardiographic indices were correlated with permanent pacemaker implantation parameters. LVMI and RWT are independent predictors of AHREs. Patients with LVMI ≥ 114.930 or RWT < 0.392 after cardiac device implantation have a high incidence of AHREs, which provides a basis for early clinical intervention.