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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Background
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“Most studies used an atrial rate limit of >175 or >180 to define an AHRE, while a few others used atrial rates that were even higher.(7,19,21) Atrial high-rate episodes were reported in 10% in the SAFE registry and in 70% in the analysis of data from the Veterans Administration Health Care System (Table 1).”
Result
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“…to detect the silent AF episodes [7,8]. hinder the possibility to diagnose the silent AF by means of occasionally performed ambulatory The most e ﬃ cient techniques of long-term monitoring are: Holter monitor, continuous telemetry [9–12], or implementable devices with internal memory [13–15].”
BackgroundMethod
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“an increased risk of stroke, systemic embolism, heart failure, and mortality.(4,6,7) It is thus important to determine whether the pacing modality can be optimized to prevent AF after pacemaker implantation for SSS.”
Background
Cryptogenic stroke: Is silent atrial fibrillation the culprit?
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Self-citation
Atrial Fibrillation
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“† Duration of AF: the longest duration of AF that can be allowed before a significant increase in the patient’s thrombo-embolic risk occurs is subject to debate, and may be as low as 5 min.(9,10) Generating a notification for short episodes could be a problem in terms of alert burden, and needs exploration.”
Background
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Self-citation
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Device-Detected Atrial Fibrillation
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“To date, only episodes lasting 5 min or more have been associated with risk for ischemic stroke [48].”
Background
The influence of atrial high-rate episodes on stroke and cardiovascular death: an update
Toennis, T., Bertaglia, E., Brandes, A., Dichtl, W., Fluschnik, N., de Groot, J. R., Marijon, É., Mont, L., Blomström‐Lundqvist, C., Cabanelas, N., et al. (2023) · EP Europace · doi:10.1093/europace/euad166 · Cited by 53
Ambulatory ECG Monitoring in Atrial Fibrillation Management
Rosero, S. Z., Kutyifa, V., Olshansky, B., & Zaręba, W. (2013) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2013.10.001 · Cited by 51
Real-World Experience with Insertable Cardiac Monitors to Find Atrial Fibrillation in Cryptogenic Stroke
Ziegler, P., Rogers, J., Ferreira, S. W., Nichols, A. J., Sarkar, S., Koehler, J. L., Warman, E. N., & Richards, M. (2015) · Cerebrovascular Diseases · doi:10.1159/000439063 · Cited by 48
New Appraisal of Atrial Fibrillation Burden and Stroke Prevention
PASSMAN, R. S., & Bernstein, R. A. (2016) · Stroke · doi:10.1161/strokeaha.115.009930 · Cited by 52
“makers placed for sinus node dysfunction were prospectively studied for a median of 27 months.(25) Their pacemakers were programmed to log AHRE when the atrial rate was >220 bpm”
Background
2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals
Varma, N., Cygankiewicz, I., Turakhia, M. P., Heidbüchel, H., Hu, Y., Chen, L. Y., Couderc, J., Cronin, E. M., Estep, J. D., Grieten, L., et al. (2021) · Annals of Noninvasive Electrocardiology · doi:10.1111/anec.12795 · Cited by 51
The Influence of Atrial and Ventricular Pacing on the Incidence of Atrial Fibrillation: A Meta‐Analysis
Elkayam, L. U., Koehler, J. L., Sheldon, T., Glotzer, T. V., ROSENTHAL, L. S., & Lamas, G. A. (2011) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2011.03192.x · Cited by 47
Self-citation
Early Detection and Treatment of Atrial Arrhythmias Alleviates the Arrhythmic Burden in Paced Patients: The SETAM Study
Amara, W., Montagnier, C., Cheggour, S., Boursier, M., Gully, C., BARNAY, C., Georger, F., Deplagne, A., Fromentin, S., Młotek, M., et al. (2017) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13062 · Cited by 49
“Patients were eligible for enrollment in the study if they (1) had an indication for a first implantation or replacement with an Evia R© DRT dual-chamber pacemaker (Biotronik), as defined in the practice guidelines issued by the European Society of Cardiology,11 with activated RM; (2) had a CHA2DS2VASc score 212; (3)…”
BackgroundMethodInfluential
Efficacy of Low Interatrial Septum and Right Atrial Appendage Pacing for Prevention of Permanent Atrial Fibrillation in Patients With Sinus Node Disease
Verlato, R., Botto, G. L., Massa, R., Amellone, C., Perucca, A., Bongiorni, M. G., Bertaglia, E., Ziacchi, V., Piacenti, M., Rosso, A. D., et al. (2011) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.110.957126 · Cited by 49
Pacing therapy for prevention of atrial fibrillation
Ellenbogen, K. A. (2006) · Heart Rhythm · doi:10.1016/j.hrthm.2006.12.005 · Cited by 49
Verification of pacemaker automatic mode switching for the detection of atrial fibrillation and atrial tachycardia with Holter recording
de Voogt, W. G., van Hemel, N. M., van de Bos, A. A., Koistinen, J. M., & Fast, J. H. (2006) · EP Europace · doi:10.1093/europace/eul112 · Cited by 48
ISHNE/EHRA expert consensus on remote monitoring of cardiovascular implantable electronic devices (CIEDs)
Dubner, S., Auricchio, A., Steinberg, J. S., Vardas, P., Stone, P., Brugada, J., Piotrowicz, R., Hayes, D. L., Kirchhof, P., Breithardt, G., et al. (2012) · Annals of Noninvasive Electrocardiology · doi:10.1111/j.1542-474x.2011.00484.x · Cited by 47
Very Short Paroxysms Account for More Than Half of the Cases of Atrial Fibrillation Detected after Stroke and TIA: A Systematic Review and Meta-Analysis
Sposato, L. A., Cipriano, L. E., Riccio, P. M., Hachinski, V., & Saposnik, G. (2015) · International Journal of Stroke · doi:10.1111/ijs.12555 · Cited by 46
Moderate Sedation Reduces Lab Time Compared to General Anesthesia during Cryoballoon Ablation for AF Without Compromising Safety or Long‐Term Efficacy
Wasserlauf, J., Knight, B. P., LI, Z., Andrei, A., Arora, R., Chicos, A. B., Goldberger, J. J., Kim, S. S., LIN, A. C., Verma, N., et al. (2016) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.12961 · Cited by 47
Risk stratification for stroke in atrial fibrillation: a critique
Killu, A. M., Granger, C. B., & Gersh, B. J. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy731 · Cited by 50
“5 h duration.(89,90) This was in contrast to a prospective study that argued only >24 h duration is significant.”
Early detection of occult atrial fibrillation and stroke prevention
Keach, J. W., Bradley, S. M., Turakhia, M. P., & Maddox, T. M. (2015) · Heart · doi:10.1136/heartjnl-2015-307588 · Cited by 45
Frequency, Duration, and Predictors of Newly-Diagnosed Atrial Fibrillation Following Dual-Chamber Pacemaker Implantation in Patients Without a Previous History of Atrial Fibrillation
Mittal, S., Steín, K. M., Gilliam, F. R., Kraus, S. M., Meyer, T. E., & Christman, S. A. (2008) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2008.03.080 · Cited by 46
Is 7-day event triggered ECG recording equivalent to 7-day Holter ECG recording for atrial fibrillation screening?
Roten, L., Schilling, M., Haeberlin, A., Seiler, J., Schwick, N. G., Fuhrer, J., Delacrétaz, E., & Tanner, H. (2012) · Heart · doi:10.1136/heartjnl-2011-301455 · Cited by 45
Improvement of left atrial function is associated with lower incidence of atrial fibrillation and mortality after cardiac resynchronization therapy
Fung, J. W., Yip, G. W., Zhang, Q., Fang, F., Chan, J. Y., Li, C. M., Wu, L. W., Chan, G. C. P., Chan, H. C.-K., & Yu, C. (2008) · Heart Rhythm · doi:10.1016/j.hrthm.2008.02.043 · Cited by 45
What do we do about atrial high rate episodes?
Boriani, G., Vitolo, M., Imberti, J. F., Potpara, T., & Lip, G. Y. H. (2020) · European Heart Journal Supplements · doi:10.1093/eurheartj/suaa179 · Cited by 44
Availability of patient decision aids for stroke prevention in atrial fibrillation: A systematic review
O’Neill, E. S., Grande, S. W., Sherman, A. E., Elwyn, G. J., & Coylewright, M. J. (2017) · American Heart Journal · doi:10.1016/j.ahj.2017.05.014 · Cited by 43
Optimal Duration of Monitoring for Atrial Fibrillation in Cryptogenic Stroke: A Nonsystematic Review
Hariri, E. H., Hachem, A. A., Sarkis, G., & Nasr, S. (2016) · BioMed Research International · doi:10.1155/2016/5704963 · Cited by 47
“Overall, we thus conclude that increasing the monitoring duration for AF after a cryptogenic stroke to at least 72 hours will indeed enhance the detection rates, but the cost-effectiveness of thismonitoring strategy compared to longer monitoring durations is yet to be established.”
Background
Rate Control Is Preferable to Rhythm Control in the Majority of Patients With Atrial Fibrillation
Falk, R. H. (2005) · Circulation · doi:10.1161/circulationaha.104.485565 · Cited by 42
Left Atrial Appendage Closure Compared With Oral Anticoagulants for Patients With Atrial Fibrillation: A Systematic Review and Network Meta‐Analysis
Oliva, A., Ioppolo, A. M., Chiarito, M., Cremonesi, A., Azzano, A., Miccichè, E., Mangiameli, A., Ariano, F., Ferrante, G., Reimers, B., et al. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.124.034815 · Cited by 42
Prediction of Atrial Fibrillation in Patients with an Implantable Cardioverter-Defibrillator and Heart Failure
Bertini, M., Borleffs, C. J. W., Delgado, V., Ng, A. C. T., Piers, S. R. D., Shanks, M., Antoni, M. L., Biffi, M., Boriani, G., Schalij, M. J., et al. (2010) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfq126 · Cited by 42
Seasonal variation in paroxysmal atrial fibrillation documented by 24-hour Holter electrocardiogram
Watanabe, E., Kuno, Y., Takasuga, H., Tong, M., Sobue, Y., Uchiyama, T., Kodama, I., & Hishida, H. (2006) · Heart Rhythm · doi:10.1016/j.hrthm.2006.09.030 · Cited by 42
Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics
Leclercq, C., Padeletti, L., Cihak, R., Ritter, P., Milašinović, G., Gras, D., Paul, V. E., Gelder, I. C. V., Stellbrink, C., Rieger, G., et al. (2009) · EP Europace · doi:10.1093/europace/eup318 · Cited by 42
Prevalence and clinical implications of atrial fibrillation episodes detected by pacemaker in patients with sick sinus syndrome
Tse, H., & Lau, C. P. (2005) · Heart · doi:10.1136/hrt.2003.027219 · Cited by 42
CHA2DS2-VASc Score: A Predictor of Thromboembolic Events and Mortality in Patients With an Implantable Monitoring Device Without Atrial Fibrillation
Parsons, C. E., Patel, S. I., Cha, S., Shen, W.-K., Desai, S., Chamberlain, A. M., Luis, S. A., Aguilar, M. I., Demaerschalk, B. M., Mookadam, F., et al. (2017) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2016.10.008 · Cited by 42
Survey of current perspectives on consumer-available digital health devices for detecting atrial fibrillation
Ding, E., Svennberg, E., Wurster, C. J., Duncker, D., Manninger, M., Lubitz, S. A., Dickson, E. L., Fitzgibbons, T. P., AKOUM, N. W., Al‐Khatib, S. M., et al. (2020) · Cardiovascular Digital Health Journal · doi:10.1016/j.cvdhj.2020.06.002 · Cited by 43
Atrial High‐Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta‐Analysis
Sagris, D., Georgiopoulos, G., Pateras, K., Perlepe, K., Korompoki, E., Milionis, H. J., Tsiachris, D., Chan, C., Lip, G. Y. H., & Ntaios, G. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.121.022487 · Cited by 43
“AHRE definition Time cut offs Follow -up (mont hs) Outcom e Study populatio n Glotzer et al 2003 Randomize d 312 74 55 (17,6) PMs sinus node dysfunction NA longest episode 5 min 27 Stroke MOST Capucci et al 2005 Observatio nal Prospectiv e 725 71 ±11 13 (1,8) PMs class I or II ACC/AHA indication…”
Background
Atrial fibrillation burden and the risk of stroke: A systematic review and dose-response meta-analysis
Yang, S., Huang, M., Wang, A.-L., Ge, G., Ma, M., Zhi, H., & Wang, L. (2022) · World Journal of Clinical Cases · doi:10.12998/wjcc.v10.i3.939 · Cited by 42
Atrial Fibrillation in Hypertrophic Cardiomyopathy
Weissler‐Snir, A., Saberi, S., Wong, T. C., Pantazis, A. A., OWENS, A. T., Leunig, A., Alvarez, C., & Rader, F. (2024) · JACC Advances · doi:10.1016/j.jacadv.2024.101210 · Cited by 40
Effects of right low atrial septal vs. right atrial appendage pacing on atrial mechanical function and dyssynchrony in patients with sinus node dysfunction and paroxysmal atrial fibrillation
Wang, M., Siu, C., Lee, K. L., Yue, W., Yan, G., Lee, S., Lau, C.-P., & Tse, H. (2011) · EP Europace · doi:10.1093/europace/eur110 · Cited by 40
Self-citation
Stroke Prevention for Patients with Atrial Fibrillation: Beyond the Guidelines
McIntyre, W. F., & Healey, J. S. (2017) · Journal of Atrial Fibrillation · doi:10.4022/jafib.1475 · Cited by 40
Subclinical Atrial Fibrillation Burden and Adverse Clinical Outcomes in Patients With Permanent Pacemakers
Park, Y. J., Kim, J. S., Park, K., On, Y. K., & Park, S. (2021) · Stroke · doi:10.1161/strokeaha.120.031822 · Cited by 40
Rationale and design of a prospective study of the clinical significance of atrial arrhythmias detected by implanted device diagnostics: The TRENDS study
Glotzer, T. V., Daoud, E. G., Wyse, D. G., Singer, D. E., Holbrook, R., Pruett, K., Smith, K., & Hilker, C. E. (2006) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-006-7622-y · Cited by 40
Self-citation
Are atrial high rate episodes (AHREs) a precursor to atrial fibrillation?
Khan, A. A., Boriani, G., & Lip, G. Y. H. (2019) · Clinical Research in Cardiology · doi:10.1007/s00392-019-01545-4 · Cited by 39
Clinical significance of atrial fibrillation detected by cardiac implantable electronic devices
DeCicco, A. E., Finkel, J. B., Greenspon, A. J., & Frisch, D. R. (2014) · Heart Rhythm · doi:10.1016/j.hrthm.2014.01.001 · Cited by 38
Incidence of Atrial Tachyarrhythmias in Pacemaker Patients: Results from the Balanced Evaluation of Atrial Tachyarrhythmias in Stimulated Patients (BEATS) Study
Israel, C. W., Neubauer, H. P., Olbrich, H., HARTUNG, W. M., Treusch, S., Hohnloser, S. H., & on Behalf of the BEATS Study Investigators (2006) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2006.00405.x · Cited by 39
Predicting Atrial Fibrillation with High Risk of Embolization with Atrial Strain and NT-proBNP
Pagola, J., Juega, J., Pascual, J. F., Bustamante, A., Peñalba, A., Palà, E., Rodriguez, M., de Lera, M., Arenillas, J. F., Cabezas, J. A., et al. (2020) · Translational Stroke Research · doi:10.1007/s12975-020-00873-2 · Cited by 39
Atrial fibrillation burden: an update—the need for a CHA2DS2-VASc-AFBurden score
Tiver, K. D., Quah, J. X., Lahiri, A., Ganesan, A. N., & McGavigan, A. D. (2020) · EP Europace · doi:10.1093/europace/euaa287 · Cited by 40
2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals
Varma, N., Cygankiewicz, I., Turakhia, M. P., Heidbüchel, H., Hu, Y., Chen, L. Y., Couderc, J., Cronin, E. M., Estep, J. D., Grieten, L., et al. (2021) · Journal of Arrhythmia · doi:10.1002/joa3.12461 · Cited by 37
How much atrial fibrillation is too much atrial fibrillation?
Lamas, G. (2012) · New England Journal of Medicine · doi:10.1056/nejme1111948 · Cited by 36
Silent ischaemic brain lesions related to atrial high rate episodes in patients with cardiac implantable electronic devices
Benezet‐Mazuecos, J., Campal, J. M. R., Cortés, M., Iglesias, J. A., Calle, S., de la Vieja, J. J., Quinones, M. A., Sanchez-Borque, P., de la Cruz, E., Espejo, A., et al. (2014) · EP Europace · doi:10.1093/europace/euu267 · Cited by 37
“In the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST), patients with at least one AHRE exceeding 5 min were more likely to have adverse clinical outcomes, including a higher incidence of stroke, death, and subsequent AF than were patients without AHRE.(8) TRENDS was a prospective, observational…”
Influential
Clinical characteristics of patients with asymptomatic recurrences of atrial fibrillation in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico–Atrial Fibrillation (GISSI-AF) trial
Disertori, M., Lombardi, F., Barlera, S., Maggioni, A. P., Favero, C., Franzosi, M. G., Lucci, D., Staszewsky, L. I., Fabbri, G., Quintarelli, S., et al. (2011) · American Heart Journal · doi:10.1016/j.ahj.2011.05.008 · Cited by 37
“Figures vary from 16% to 31% during standard 12-lead electrocardiogram (ECG) controls(2-4) to 56% to 81% when using different telemedicine techniques(5-9) and to 51% to 74% when pacemaker or Implantable Cardioverter Defibrillator (ICD) memory system is analyzed.(10-12) It is therefore relevant to describe this phenome…”
Background
Atrial fibrillation detection using a novel three-vector cardiac implantable monitor: the atrial fibrillation detect study
Ciconte, G., Saviano, M., Giannelli, L., Ćalović, Ž., Baldi, M., Ciaccio, C., Cuko, A., Vitale, R., Giacopelli, D., Conti, M. A., et al. (2016) · EP Europace · doi:10.1093/europace/euw181 · Cited by 36

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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