Performance of the C2HEST score to predict sustained atrial high-rate episodes in patients implanted with cardiac implantable electronic device Free

Type of funding sources: None.

Sustained atrial high-rate episodes (SAHRE), which are considered ‘subclinical atrial fibrillation’ (AF), increase the risk of adverse outcomes in patients with a cardiac implantable electronic device (CIED). Risk stratification for the development of SAHREs has never been investigated.

To assess test the performance of the C2HEST score (coronary artery disease or chronic obstructive pulmonary disease [1 point each]; hypertension [1 point]; elderly [age ≥75 years, 2 points]; systolic heart failure [2 points]; thyroid disease [1 point]) in predicting SAHRE in patients implanted with CIED without AF.

Retrospective study including 500 consecutive patients implanted with CIEDs in the West Birmingham in the UK. Patients were followed after implantation to record the development of SAHRE lasting >24h. Risk factors and incidence of SAHRE were analyzed. The predictive value of the C2HEST score for SAHRE prediction was evaluated.

During 53.1 months of follow-up, 44 (8.8%) patients developed SAHRE. SAHRE was associated with higher all-cause mortality (P < 0.001) and ischemic stroke (P = 0.001). Age and heart failure were associated with SAHRE occurrence. The incidence of SAHRE increased by the C2HEST score (39% higher risk per point increase)(table). Among those with C2HEST score ≥4, the incidence of SAHRE was 3.62%/year (95%CI 2.14-5.16). The C2HEST score had a moderate predictive capability (area under the curve 0.73 [95%CI 0.64-0.81]) and discriminative ability (log-rank P = 0.003), which was better than other clinical scores (CHA2DS2-VASc, CHADS2, HATCH).

The C2HEST score predicted SAHRE incidence in non-AF subjects with CIED, with the highest risk seen in patients with C2HEST score ≥4 The benefit of using the C2HEST score in clinical practice in this patient population needs further investigation.