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This study aimed to evaluate the independent and synergistic predictive value of clinical, echocardiographic, and device-derived parameters for the onset of AHRE\u2009\u2265\u200930\u00a0s.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective single-center cohort study, 165 patients undergoing\n                      <jats:italic>de novo<\/jats:italic>\n                      dual-chamber pacemaker implantation were enrolled. Baseline clinical characteristics, echocardiographic indices (including Diastolic Wall Strain [DWS]), biomarkers (NT-proBNP), and device parameters (Atrial Pacing Percentage [AP%] and Paced P-wave Duration [PPD]) were analyzed. The primary endpoint was the first occurrence of AHRE\u2009\u2265\u200930\u00a0s.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median follow-up of 10.5 months, the incidence of AHRE was 21.8% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200936). Multivariate Cox regression identified five independent predictors: PPD\u2009\u2265\u2009160 ms (HR 4.12), AP% \u2265 50% (HR 3.05), DWS\u2009\u2264\u20090.34 (HR 2.75), Log-transformed NT-proBNP (HR 1.28), and Age (HR 1.24 per 5-year increase). A comprehensive model integrating these factors demonstrated superior discrimination (C-index 0.81) compared to a baseline clinical model (C-index 0.69) and achieved a significant net reclassification index (NRI) of 0.41.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Intrinsic electrophysiological markers (prolonged PPD) and mechanical indices of left ventricular stiffness (low DWS) are powerful independent predictors of AHRE. Integrating these parameters significantly improves risk stratification, offering a practical tool for personalized monitoring and management strategies in pacemaker recipients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-026-05573-7","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T13:36:18Z","timestamp":1770730578000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Incremental predictive value of device and echocardiographic parameters for atrial high-rate episodes: a prospective cohort study"],"prefix":"10.1186","volume":"26","author":[{"given":"Thanh Van","family":"Le","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang","family":"Doan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linh Ha Khanh","family":"Duong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"issue":"7","key":"5573_CR1","doi-asserted-by":"publisher","first-page":"430","DOI":"10.31128\/AJGP-05-23-6847","volume":"53","author":"MK Rowe","year":"2024","unstructured":"Rowe MK, Shanahan L. 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