Cited by 750Cardiac pacing and defibrillation studiesCardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmias

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Atrial High Rate Episodes Detected by Pacemaker Diagnostics Predict Death and Stroke: Report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST)

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Glotzer, Taya V., Hellkamp, Anne S., Zimmerman, John, Sweeney, Michael O., Yee, Raymond, Marinchak, Roger, Cook, James, Paraschos, Alexander, Love, John, Radoslovich, Glauco, Lee, Kerry L., Lamas, Gervasio A.·2003·Circulation

DOI 10.1161/01.cir.0000057981.70380.45

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Abstract

Background— Some current pacing systems can automatically detect and record atrial tachyarrhythmias that may be asymptomatic. We prospectively studied a 312-patient (pt) subgroup of MOST (MOde Selection Trial), a 2010-patient, 6-year randomized trial of DDDR versus VVIR pacing in sinus node dysfunction (SND). The purpose of the study was to correlate atrial high rate events (AHREs) detected by pacemaker diagnostics with clinical outcomes. Methods and Results— Pacemakers were programmed to log an AHRE when the atrial rate was >220 bpm for 10 consecutive beats. Analysis was confined to patients with at least 1 AHRE duration exceeding 5 minutes. The 312 patients were median age 74 years, 55% female, and 60% had a history of SVT. 160 of 312 (51.3%) patients enrolled had at least 1 AHRE >5 minutes duration over median follow-up of 27 months. Cox proportional hazards analysis assessed the relationship of AHREs with clinical events, adjusting for prognostic variables and baseline covariates. The presence of any AHRE was an independent predictor of the following: total mortality (hazard ratio AHRE versus no AHRE and 95% confidence intervals=2.48 [1.25, 4.91], P =0.0092); death or nonfatal stroke (2.79 [1.51, 5.15], P =0.0011); and atrial fibrillation (5.93 [2.88, 12.2], P =0.0001). There was no significant effect of pacing mode on the presence or absence of AHREs. Conclusions— AHRE detected by pacemakers in patients with SND identify patients that are more than twice as likely to die or have a stroke, and 6 times as likely to develop atrial fibrillation as similar patients without AHRE.

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Incidence of Previously Undiagnosed Atrial Fibrillation Using Insertable Cardiac Monitors in a High-Risk Population
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Heart Failure During Cardiac Pacing
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Self-citation
Screening for atrial fibrillation: a European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLAECE).
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“Several observational and randomized studies demonstrated that atrial high rate events (AHRE) detected by CIEDs were associated with increased risk of subsequent stroke, systemic embolic events and mortality in patients with implanted cardioverter-defibrillators (ICDs), PMs and cardiac resynchronization therapy device…”
Background
Device-detected subclinical atrial tachyarrhythmias: definition, implications and management—an European Heart Rhythm Association (EHRA) consensus document, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE)
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“In early 2000s, two studies of patients with pacemakers implanted for sinus node disease have reported atrial arrhythmias in 50–68% of patients.(5,16) More recently, Healey et al.”
BackgroundInfluentialSelf-citation
Smartwatch Performance for the Detection and Quantification of Atrial Fibrillation
Wasserlauf, J., You, C., Patel, R., Valys, A., Albert, D., & Passman, R. (2019) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.118.006834 · Cited by 245
Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options—a report from the 3rd Atrial Fibrillation Competence NETwork/European Heart Rhythm Association consensus conference
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“The available data suggest that these patients are at increased risk for stroke and also put forward the concept that patients who spend more time in AF are at higher risk for complications than patients who spend less time in AF (27).”
Background
Symptoms and Functional Status of Patients With Atrial Fibrillation: State of the Art and Future Research Opportunities
Rienstra, M., Lubitz, S. A., Mahida, S., Magnani, J. W., Fontes, J. D., Sinner, M. F., Van Gelder, I. C., Ellinor, P. T., & Benjamin, E. J. (2012) · Circulation · doi:10.1161/circulationaha.111.069450 · Cited by 237
Probing oral anticoagulation in patients with atrial high rate episodes: Rationale and design of the Non–vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH–AFNET 6) trial
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“This is in line with predictions made from trial data sets.19 Systematic ECG monitoring in stroke survivors detects silent paroxysmal AF in approximately 5% of unselected stroke patients13,20 and in up to 20% when long-term ECG monitoring is applied to patients with cryptogenic stroke.21-23 Even these prolonged ECG mo…”
BackgroundResultInfluential
Sinus Node and Atrial Arrhythmias
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“The presence of AF, even when subclinical (detected only by pacemaker diagnostic in the absence of symptoms) portends increased risk of stroke, death, and the likelihood of the development of clinical AF.(23,24)”
Background
Fibrotic Atrial Cardiomyopathy, Atrial Fibrillation, and Thromboembolism
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Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke
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“Two cohort studies in pacemaker patients demonstrated that subclinical AF as brief as 5 or 6 minutes in duration is associated with an increased risk of stroke.(24,25) However, many strokes in the pacemaker studies occurred without the development of longer-lasting AF episodes or lacked a temporal association with the…”
Early and comprehensive management of atrial fibrillation: executive summary of the proceedings from the 2nd AFNET-EHRA consensus conference ‘research perspectives in AF’
Kirchhof, P., Bax, J., Blomstrom-Lundquist, C., Calkins, H., Camm, A. J., Cappato, R., Cosio, F., Crijns, H., Diener, H.-C., Goette, A., et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp235 · Cited by 202
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Screening for Atrial Fibrillation in the Older Population
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Electrocardiographic patch devices and contemporary wireless cardiac monitoring
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“Using pacemakers programmed to log rapid atrial rate, atrial tachyarrhythmia was also found to be an independent predictor of death in the MOde Selection Trial (MOST) study (Glotzer et al., 2003).”
Background
Uncovering Atrial Fibrillation Beyond Short-Term Monitoring in Cryptogenic Stroke Patients
Brachmann, J., Morillo, C. A., Sanna, T., Lazzaro, V. D., Diener, H., Bernstein, R. A., Rymer, M., Ziegler, P., Liu, S., & PASSMAN, R. S. (2016) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.115.003333 · Cited by 183
“The Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial (ASSERT), performed in patients without stroke and carriers of a cardiac implantable electronic device, found that AF episodes lasting >6 minutes were associated with an increased…”
Result
Detection of atrial high-rate events by continuous Home Monitoring: clinical significance in the heart failure-cardiac resynchronization therapy population
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Positive predictive value of device-detected atrial high-rate episodes at different rates and durations: An analysis from ASSERT
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ISHNE/EHRA expert consensus on remote monitoring of cardiovascular implantable electronic devices (CIEDs)
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Screening for atrial fibrillation: a call for evidence
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Incidence of Newly Detected Atrial Arrhythmias via Implantable Devices in Patients With a History of Thromboembolic Events
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Self-citation
Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation
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Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association
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Remote control of implanted devices through Home MonitoringTM technology improves detection and clinical management of atrial fibrillation
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Performance of a new atrial fibrillation detection algorithm in a miniaturized insertable cardiac monitor: Results from the Reveal LINQ Usability Study
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Clinical Implications of Brief Device-Detected Atrial Tachyarrhythmias in a Cardiac Rhythm Management Device Population
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Authors: Glotzer, T. V., Hellkamp, A. S., Zimmerman, J., Sweeney, M. O., Yee, R., Marinchak, R., Cook, J., Paraschos, A., Love, J., Radoslovich, G., Lee, K. L., & Lamas, G. A.
Affiliations: Brigham and Women's Hospital (US)
ORCID: Glotzer, Taya V.
Hellkamp, Anne S.
Zimmerman, John
Yee, Raymond
Lamas, Gervasio A.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2003-04
Volume: 107
Issue: 12
Pages: 1614-1619
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.0000057981.70380.45
OpenAlex: W2149989524
Cited by: 750
References: 28
Citations by year: 2026: 16 · 2025: 21 · 2024: 31 · 2023: 26 · 2022: 23 · 2021: 50 · 2020: 38 · 2019: 50 · 2018: 52 · 2017: 64 · 2016: 56 · 2015: 46 · 2014: 44 · 2013: 32 · 2012: 34
FWCI: 12.56
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Funders: Medtronic
National Institutes of Health (5u01hl053973-05, 5u01hl055981-05)
National Heart, Lung, and Blood Institute (HL 53973, U01HL049804, U01 HL 53973, U01-HL-49804, U01-HL-55981)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords: atrial high-rate episodes, atrial tachyarrhythmia, sick sinus syndrome, DDDR pacing, VVIR pacing, mode choice, atrial fibrillation, mortality, stroke, prognostic factors, asymptomatic arrhythmia
MeSH terms: Adult, Aged, Arrhythmias, Cardiac, Arrhythmia, Sinus, Atrial Fibrillation, Cardiac Pacing, Artificial, Female, Heart Atria, Humans, Male, Middle Aged, Electrocardiography, Ambulatory, Stroke

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Atrial High Rate Episodes Detected by Pacemaker Diagnostics Predict Death and Stroke: Report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST)

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