الفهرس 
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Abstract
Atrial fibrillation (AF) is the commonest type of sustained arrhythmia, and it is usually associated with high risks of morbidity and deaths. Despite the increasingly recognized integrated management as anticoagulation therapy in AF patients, there are still a significant number of patients with AF admitted with heart failure, stroke, and other comorbidities. This is explained by the asymptomatic nature of AF. About 33.3% of patients did not recognize any symptoms of AF (e.g., shortness of breath, or chest pain or palpitations), this leads to delay in AF detection and the initiation of anticoagulation treatment. Many asymptomatic cases of AF are diagnosed only after the occurrence of complications as congestive heart failure and ischemic stroke. Modern pacemaker technology has low-power consumption memory, high-density and are able to automatically record and store episodes of spontaneous atrial tachy-arrhythmias according to program detection criteria. These episodes can be recorded as interval information, electrograms, or both. It is thought that these episodes represent non sustainable AF may be harbingers of sustained AF. Many studies conducted as cross-sectional of unselected patients with pacemaker recorded as a high occurrence rate of atrial high-rate events (AHREs), but their clinical importance is still question The aim of the study is to assess the incidence of atrial high-rate episodes in patients with implantable cardiac devices and to determine their characteristics. This prospective observational study was conducted at Tanta University Hospital on patients with implantable cardiac device attended the cardiovascular outpatient clinic. Informed consent was obtained from all patients. The inclusion criteria included patients with implantable cardiac device that includes an Atrial lead. On the other hand, the exclusion criteria included patients with permanent Atrial fibrillation and patients who refused to join the study. All patients in this study were subjected to demographic data, full history, clinical examination, ECG and Echo. Data was collected, coded and entered to Excel sheet, analyzed using SPSS version 25. Data was presented and suitable analysis was done according to the type of data obtained for each parameter. The data was analyzed by SPSS (statistical package for social science) version 26.0 on IBM compatible computer (SPSS Inc., Chicago, IL, USA). The qualitative data was described as number and percentage and analyzed by using Chi square test and Fisher‘s exact test. Quantitative data were tested for normality using Shapiro‐Wilks test, assuming normality at P > 0.05. Quantitative data was described as mean, standard deviation, using Student’s ”t” test, and one way ANOVA test. The accepted level of significance in this work started at 0.05 (P < 0.05 was considered significant). We included 100 participants involved a nearly half of the patient (47%) detected with AHRE. Regarding the demographic characteristics, our study revealed no significant relationship between AHRE detection with both age (P = 0.897) and gender (P = 0.624) of the patients. General medical history of included patients revealed no significant association with AHRE except for IHD patients. The analysis revealed a significant increase in AHRE detection in IHD patients with a p-value of 0.042. On the other hand, no direct significant association between AHRE and either diabetes, HTN, smoking, or medications. Similarly, in terms of cardiac-related history, the result of general history and AHRE detection showed no significant relationship exists between AHRE and either prosthetic valve, ejection fraction (EF), LA dimensions, valvular lesions, or type of pacemaker. We concluded that, AHREs have significant incidence in patients with cardiac implanted devices. Following advances in cardiac monitoring, it is likely that AHRE will be increasingly reported in the future. This view has been supported by previous studies demonstrating that AHREs have a high correlation with clinically documented AF. Further studies are necessary to understand the underlying pathogenic mechanisms behind AHRE and to guide the management of this arrythmia and its complications.