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The cutoff threshold for AHRE duration for MACE, with\/without history of atrial fibrillation (AF) or myocardial infarction (MI), is unknown. A total of 481 consecutive patients with\/without history of AF or MI receiving dual-chamber pacemaker implantation were included. The primary outcome was a composite endpoint of MACE after AHRE\u2009\u2265\u20095\u00a0min,\u2009\u2265\u20096\u00a0h, and\u2009\u2265\u200924\u00a0h. AHRE was defined as\u2009&gt;\u2009175\u00a0bpm (MEDTRONIC) or\u2009&gt;\u2009200\u00a0bpm (BIOTRONIK) lasting\u2009\u2265\u20095\u00a0min. Cox regression analysis with time-dependent covariates was conducted. Patients\u2019 mean age was 75.3\u2009\u00b1\u200910.7\u00a0years and 188 (39.1%) developed AHRE\u2009\u2265\u20095\u00a0min, 115 (23.9%)\u2009\u2265\u20096\u00a0h, and 83 (17.3%)\u2009\u2265\u200924\u00a0h. During follow-up (median 39.9\u2009\u00b1\u200929.8\u00a0months), 92 MACE occurred (IR 5.749%\/year, 95% CI 3.88\u20135.85). AHRE\u2009\u2265\u20095\u00a0min (HR 5.252, 95% CI 2.575\u201310.715, P\u2009&lt;\u20090.001) and\u2009\u2265\u20096\u00a0h (HR 2.548, 95% CI 1.284\u20135.058, P\u2009=\u20090.007) was independently associated with MACE, but not AHRE\u2009\u2265\u200924\u00a0h. Patients with history of MI (IR 17.80%\/year) had higher MACE incidence than those without (IR 3.77%\/year, p\u2009=\u20090.001). Significant differences were found between MACE patients with\/without history of AF in AHRE\u2009\u2265\u20095\u00a0min but not AHRE\u2009\u2265\u20096\u00a0h or\u2009\u2265\u200924\u00a0h. Patients with dual-chamber pacemakers who develop AHRE have increased risk of MACE, particularly after history of AF or MI.<\/jats:p>","DOI":"10.1038\/s41598-021-85301-7","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T11:03:49Z","timestamp":1615460629000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Atrial high\u2011rate episodes and risk of major adverse cardiovascular events in patients with dual chamber permanent pacemakers: a retrospective study"],"prefix":"10.1038","volume":"11","author":[{"given":"Wei-Da","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2760-9978","authenticated-orcid":false,"given":"Ju-Yi","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,11]]},"reference":[{"key":"85301_CR1","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/ejcts\/ezw313","volume":"50","author":"P Kirchhof","year":"2016","unstructured":"Kirchhof, P. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. 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