心房高频事件——从设备检测指标到早期心房疾病表型的临床认识进展

Atrial High-Rate Episodes—Advances in Clinical Understanding from Device-Detected Markers to Early Atrial Disease Phenotypes

摘要: 心房高频事件(atrial high-rate episodes, AHRE)是心脏植入式电子设备(cardiac implantable electronic devices, CIED)检测到的一种常见但临床意义不断演变的电生理现象。随着植入式设备技术的普及，AHRE的检出率显著提高，但其确切的病理生理机制、与临床心房颤动(atrial fibrillation, AF)的关系以及对远期预后的影响，尤其是卒中风险的评估，仍是当前心血管领域的研究热点与争议所在。本文围绕AHRE的定义演变、检测技术、病理生理基础、临床预后及管理策略进行综述，并深入探讨了其与早期心房心肌病、心房纤维化等潜在心房疾病表型的关联机制。通过整合分析最新的流行病学数据、病理生理研究及临床预后证据，本文旨在构建一个从孤立设备指标到系统性心房疾病早期识别与风险分层的整合认知框架，以期为临床实践中对AHRE患者的精准管理和干预决策提供循证依据。

Abstract: Atrial high-rate episodes (AHREs) are a common electrophysiological phenomenon detected by cardiac implantable electronic devices (CIEDs) whose clinical significance continues to evolve. With the widespread adoption of implantable device technology, the detection rate of AHREs has increased substantially; however, their precise pathophysiological mechanisms, relationship with clinical atrial fibrillation, and impact on long-term prognosis—particularly stroke risk assessment—remain active areas of research and debate in cardiovascular medicine. This article reviews the evolving definition, detection technology, and diagnostic criteria of AHREs, and further explores the mechanistic links between AHREs and potential atrial disease phenotypes, including early atrial cardiomyopathy and atrial fibrosis. By integrating the latest epidemiological data, pathophysiological research, and clinical outcome evidence, this review aims to establish a comprehensive cognitive framework that transitions from isolated device-detected markers to systematic early identification and risk stratification of atrial disease, thereby providing an evidence-based foundation for precision management and intervention decision-making in patients with AHREs.