Investigation of Silent Neurological Ischemia in Pacemaker-Implanted Patients with Atrial High-Rate Episodes (AHRE)
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BACKGROUND Atrial high-rate episode (AHRE) is defined according to the European Society of Cardiology (ESC) guidelines as a heart rate of ≥175 bpm lasting at least 5 minutes. This study aimed to investigate whether neuron-specific enolase (NSE) levels, an indicator of silent neurological ischemia, could be used as an effective biomarker to demonstrate silent neurological ischemia in patients with detected AHRE and to examine factors associated with AHRE. METHODS Patients with AHRE detected in pacemaker analysis and a control group without any arrhythmias were included. Patients with AHRE were divided into subgroups according to AHRE duration: Group 1: AHRE <5 minutes, Group 2: AHRE ≥5 minutes - <1 hour, Group 3: AHRE ≥1 hour - <24 hours, Group 4: AHRE ≥24 hours. Neuron-specific enolase (NSE) levels of the patients were measured. RESULTS There were 160 patients, including 80 (50.0%) in the AHRE group and 80 (50.0%) in the control group. According to AHRE duration, there were 24 (30.0%) patients in Group 1, 33 (41.2%) in Group 2, 19 (23.8%) in Group 3, and 4 (5.0%) in Group 4. Patients with AHRE had statistically significant differences in age, sPAP, transmitral E/A ratio and NSE levels. The mean NSE levels of all groups were significantly different (p<0.001). Correlation analysis in patients with AHRE showed a very strong positive correlation between AHRE duration and NSE values as well as correlations with age, CHA 2 DS 2 -VASc score and LA diameter. NSE levels were positively correlated with AHRE duration and LA diameter. AHRE duration was an independent predictor of elevated NSE levels. CONCLUSION It was shown that AHRE is associated with silent neurological ischemia and that NSE levels can be used to demonstrate these neurological effects. Future studies can contribute to the development of more effective treatment strategies based on these findings by investigating the neurological effects of AHRE in more detail.
