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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Impact of atrial high-rate episodes on the risk of future stroke
Nakano, M., Kondo, Y., Nakano, M., Kajiyama, T., Hayashi, T., Ito, R., Takahira, H., & Kobayashi, Y. (2019) · Journal of Cardiology · doi:10.1016/j.jjcc.2019.01.006 · Cited by 26
Subclinical Atrial Fibrillation and Risk of Stroke: Past, Present and Future
AlTurki, A., Marafi, M., Russo, V., Proietti, R., & Essebag, V. (2019) · Medicina · doi:10.3390/medicina55100611 · Cited by 27
“AHRE was an independent predictor of death or stroke [16].”
BackgroundMethodInfluential
Rhythm monitoring strategies in patients at high risk for atrial fibrillation and stroke: A comparative analysis from the REVEAL AF study
Reiffel, J. A., Verma, A., Kowey, P. R., Halperin, J. L., Gersh, B. J., Elkind, M. S. V., Ziegler, P., Kaplon, R. E., Sherfesee, L., & Wachter, R. (2019) · American Heart Journal · doi:10.1016/j.ahj.2019.07.016 · Cited by 26
Estimated incidence of previously undetected atrial fibrillation on a 14-day continuous electrocardiographic monitor and associated risk of stroke
McIntyre, W. F., Wang, J., Benz, A. P., Johnson, L., Connolly, S. J., Gelder, I. C. V., Lópes, R. D., Gold, M. R., Hohnloser, S. H., Lau, C., et al. (2021) · EP Europace · doi:10.1093/europace/euab324 · Cited by 26
The Multiple Causes of Stroke in Atrial Fibrillation: Thinking Broadly
D’Souza, A., Butcher, K., & Buck, B. H. (2018) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2018.08.036 · Cited by 24
Asymptomatic Atrial Fibrillation on Device Interrogation
Lim, H. S., & Lip, G. Y. H. (2008) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01194.x · Cited by 26
Effectiveness of pacemaker tele‐monitoring on quality of life, functional capacity, event detection and workload: The PONIENTE trial
López-Villegas, A., Catalán-Matamoros, D., Robles‐Musso, E., & Peiró, S. (2015) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.12612 · Cited by 26
Simulation of Daily Snapshot Rhythm Monitoring to Identify Atrial Fibrillation in Continuously Monitored Patients with Stroke Risk Factors
Yano, Y., Greenland, P., Lloyd‐Jones, D. M., Daoud, E. G., Koehler, J. L., & Ziegler, P. (2016) · PLoS ONE · doi:10.1371/journal.pone.0148914 · Cited by 25
Controversies in postoperative atrial fibrillation after noncardiothoracic surgery: clinical and research implications
Vallurupalli, S., Shanbhag, A., & Mehta, J. L. (2017) · Clinical Cardiology · doi:10.1002/clc.22652 · Cited by 25
Detection of subclinical atrial fibrillation after cryptogenic stroke using implantable cardiac monitors
Ungar, A., Pescini, F., Rafanelli, M., Angelis, M. V. D., Faustino, M., Tomaselli, C., Petrone, A., Forleo, G. B., Morani, G., Forlivesi, S., et al. (2021) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2021.06.022 · Cited by 25
Silent Atrial Fibrillation in Elderly Pacemaker Users: A Randomized Trial Using Home Monitoring
Lima, C., Martinelli, M., Peixoto, G., de Siqueira, S. F., Wajngarten, M., Silva, R. T., Costa, R., Filho, R. K., & Ramires, J. A. F. (2015) · Annals of Noninvasive Electrocardiology · doi:10.1111/anec.12294 · Cited by 25
A randomized trial of budiodarone in paroxysmal atrial fibrillation
For the PASCAL Investigators, Ezekowitz, M. D., Nagarakanti, R., Lubiński, A., Bandman, O., Canafax, D. M., Ellis, D., Milner, P. G., Ziola, M., Thibault, B., et al. (2011) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-011-9636-3 · Cited by 27
Embolic and Other Adverse Outcomes in Symptomatic Versus Asymptomatic Patients With Atrial Fibrillation (from the ORBIT-AF Registry)
Thind, M., Holmes, D. N., Badri, M., Pieper, K. S., Singh, A., Blanco, R. G., Steinberg, B. A., Fonarow, G. C., Gersh, B. J., Mahaffey, K. W., et al. (2018) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2018.07.045 · Cited by 25
Atrial high rate episodes in patients with cardiac implantable electronic devices: implications for clinical outcomes
Miyazawa, K., Pastori, D., Li, Y., Székely, O., Shahid, F., Boriani, G., & Lip, G. Y. H. (2019) · Clinical Research in Cardiology · doi:10.1007/s00392-019-01432-y · Cited by 25
An Argument for Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation
ZIMETBAUM, P. J. (2005) · Circulation · doi:10.1161/circulationaha.104.537175 · Cited by 24
Prevalence and Predictors of Clinically Relevant Atrial High-Rate Episodes in Patients with Cardiac Implantable Electronic Devices
Kim, M. H., Kim, T., Yu, H. T., Choi, E., Park, H.-S., Park, J., Lee, Y. S., Kang, K., Uhm, J., Sung, J., et al. (2020) · Korean Circulation Journal · doi:10.4070/kcj.2020.0393 · Cited by 23
New Frontiers for Stroke Prevention in Atrial Fibrillation
Prasad, V. K., Kaplan, R. M., & PASSMAN, R. S. (2012) · Cerebrovascular Diseases · doi:10.1159/000334979 · Cited by 23
Incidence and Clinical Significance of New-Onset Device-Detected Atrial Tachyarrhythmia
Belkin, M. N., Soria, C. E., Waldo, A. L., Borleffs, C. J. W., Hayes, D. L., Tung, R. H., Singh, J. P., & Upadhyay, G. A. (2018) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.117.005393 · Cited by 23
Ischemic Stroke Phenotype in Patients With Nonsustained Atrial Fibrillation
Arsava, E. M., Baş, D. F., Atalar, E., Has, A. C., Oğuz, K. K., & Topçuoğlu, M. A. (2015) · Stroke · doi:10.1161/strokeaha.114.006396 · Cited by 23
“All these findings fit well into the recent observations that short supraventricular runs designate initial stages of left atrial remodeling and therefore are a predictor of future AF.(12,13) Leaving aside the prognostic value in predicting conversion into persistent AF, the more critical question is whether nonsustai…”
Result
Subclinical atrial fibrillation and stroke: insights from continuous monitoring by implanted cardiac electronic devices
Lau, C., Siu, C.-W., Yiu, K., Lee, K. L., Chan, Y., & Tse, H. (2015) · EP Europace · doi:10.1093/europace/euv235 · Cited by 23
“Five large studies have examined the relationship of CIED recorded SCAF and future thrombo-embolic risk (Table 2).(20) – 22,26,27 With the exception of the ASSERT, all studies had included some or all patients with prior history of clinical AF.”
BackgroundSelf-citation
P‐wave and interatrial block: New predictor for atrial high rate episodes in patients with cardiac implantable electronic devices
Campal, J. M. R., Benezet‐Mazuecos, J., Bravo, J. A. I., Borque, P. S., Blanco, Á. M., Alarcón, J. J. D. L. V., Mariscal, J. M., Baranchuk, A. M., & Farré, J. (2018) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13268 · Cited by 23
Prospective Randomized Study of Mode Switching in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction
Sweeney, M. O., Hellkamp, A. S., Ellenbogen, K. A., Glotzer, T. V., Silverman, R., Yee, R. K., Lee, K. L., Lamas, G. A., & for the MOST Investigators (2004) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2004.03146.x · Cited by 23
Self-citation
2020 Clinical practice guidelines for Supraventricular tachycardia in adults
Bokeria, L. A., Golukhova, E. Z., Popov, S. V., Artyukhina, Е. А., Базаев, В. А., Batalov, R. E., Bokeria, O. L., Vygovsky, A. B., Gilyarov, M. Y., Sp, G., et al. (2021) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2021-4484 · Cited by 23
Comprehensive atrial fibrillation burden and symptom reduction post-ablation: insights from DECAAF II
Noujaim, C., Assaf, A. Y. M., Lim, C., Feng, H., Younes, H., Mekhael, M., Chouman, N., Shamaileh, G., Hajjar, A. H. E., Ayoub, T. H., et al. (2024) · EP Europace · doi:10.1093/europace/euae104 · Cited by 24
“Recently, there has been a paradigm shift in defining AF as a disease Catheter ablation reduces AF burden reflected by its burden, such as the percentage of time spent in AF 6–10 or symptom burden.”
Background
Atrial Dysfunction and Interatrial Dyssynchrony Predict Atrial High Rate Episodes: Insight into the Distinct Effects of Right Atrial Appendage Pacing
Xie, J., Fang, F., Zhang, Q., Chan, J. Y., Yip, G. W., Sanderson, J. E., Lam, Y., YAN, B. P. ‐., & Yu, C. (2011) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2011.02210.x · Cited by 22
Position paper for management of elderly patients with pacemakers and implantable cardiac defibrillators: Groupe de Rythmologie et Stimulation Cardiaque de la Société Française de Cardiologie and Société Française de Gériatrie et Gérontologie
Fauchier, L., Alonso, C., Anselme, F., Blangy, H., Bordachar, P., Bovéda, S., Clémenty, N., Defaye, P., Deharo, J., Friocourt, P., et al. (2016) · Archives of cardiovascular diseases · doi:10.1016/j.acvd.2016.04.004 · Cited by 22
Detection and management of atrial fibrillation after cryptogenic stroke or embolic stroke of undetermined source
Sanna, T., Ziegler, P., & Crea, F. (2018) · Clinical Cardiology · doi:10.1002/clc.22876 · Cited by 23
Relationship between device-detected burden and duration of atrial fibrillation and risk of ischemic stroke
Al‐Gibbawi, M., Ayinde, H. O., Bhatia, N. K., El‐Chami, M. F., Westerman, S. B., León, A. R., SHAH, A. D., Patel, A. M., Lurgio, D. B. D., TOMPKINS, C. M., et al. (2020) · Heart Rhythm · doi:10.1016/j.hrthm.2020.10.017 · Cited by 21
Associations of Left Atrial Function and Structure With Supraventricular Ectopy: The Multi‐Ethnic Study of Atherosclerosis
Heckbert, S. R., Jensen, P. N., Austin, T. R., Chen, L. Y., Post, W. S., Ambale‐Venkatesh, B., Soliman, E. Z., Floyd, J. S., Sotoodehnia, N., Kronmal, R. A., et al. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.120.018093 · Cited by 22
“18 In sensitivity analyses, we examined whether associations differed: (1) with additional adjustment for a history of stroke, myocardial infarction, or heart failure before CMR imaging; (2) in analyses restricted to those with no history of clinically recognized AF, stroke, myocardial infarction, or heart failure; (3…”
Method
The Managed Ventricular Pacing™ Versus VVI 40 Pacing (MVP) Trial: Clinical Background, Rationale, Design, and Implementation
Sweeney, M. O., Ellenbogen, K. A., Miller, E. H., Sherfesee, L., Sheldon, T., & Whellan, D. J. (2006) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2006.00656.x · Cited by 22
Self-citation
Ventricular high-rate episodes in pacemaker diagnostics identify a high-risk subgroup of patients with tachy-brady syndrome
Willems, R., Morck, M. L., Exner, D. V., Rose, S., & Gillis, A. M. (2004) · Heart Rhythm · doi:10.1016/j.hrthm.2004.06.004 · Cited by 22
Long-term Success and Follow-up After Atrial Fibrillation Ablation
Kircher, S., Hindricks, G., & Sommer, P. (2012) · Current Cardiology Reviews · doi:10.2174/157340312803760758 · Cited by 21
Artificial intelligence predicts clinically relevant atrial high-rate episodes in patients with cardiac implantable electronic devices
Kim, M. H., Kang, Y., You, S. C., Park, H., Lee, S., Kim, T., Yu, H. T., Choi, E., Park, H., Park, J., et al. (2022) · Scientific Reports · doi:10.1038/s41598-021-03914-4 · Cited by 22
“The study population included patients (1) eligible for permanent pacemaker implantation according to the guidelines on cardiac pacemaker implantation for sick sinus syndrome (sinus bradycardia, sinus pause of ≥ 3 s, tachy-brady syndrome, sinus node dysfunction, and chronotropic incompetence) or atrioventricular block…”
Method
How should I treat patients with subclinical atrial fibrillation and atrial high-rate episodes? Current evidence and clinical importance
Kreimer, F., Mügge, A., & Gotzmann, M. (2022) · Clinical Research in Cardiology · doi:10.1007/s00392-022-02000-7 · Cited by 23
“Glotzer et al (2003) [29] Analysis of the multicentre, prospective, randomized MOST trial 312 Patients with atrial high-rate episodes were 6 times as likely to develop clinical AF”
BackgroundResultInfluential
Increased base rate of atrial pacing for prevention of atrial fibrillation after implantation of a dual-chamber pacemaker: insights from the Atrial Overdrive Pacing Study
Kantharia, B. K., Freedman, R. A., Hoekenga, D. E., TOMASSONI, G. F., WORLEY, S. J., SORRENTINO, R. A., Steinhaus, D. A., Wolkowicz, J. M., Syed, Z., & and the AOP Study Investigators (2007) · EP Europace · doi:10.1093/europace/eum170 · Cited by 21
Predictors and long-term clinical outcomes of newly developed atrial fibrillation in patients with cardiac implantable electronic devices
Kim, B. S., Chun, K. J., Hwang, J. K., Park, S., Park, K., Kim, J. S., & On, Y. K. (2016) · Medicine · doi:10.1097/md.0000000000004181 · Cited by 21
“With respect to individuals who have never experienced AF, the CIED approach detects newly developed AF more frequently than do conventional diagnostic methods, which is important given the association of AF with a significantly increased risk of future cardiovascular events.([4,5]) To date, several clinical condition…”
Influential
Clinical significance of atrial high-rate episodes for thromboembolic events in Japanese population
Kawakami, H., Nagai, T., Saito, M., Inaba, S., Seike, F., Nishimura, K., Inoue, K., Okura, T., Sumimoto, T., Uemura, S., et al. (2017) · Heart Asia · doi:10.1136/heartasia-2017-010954 · Cited by 22
Extended ECG monitoring with an implantable loop recorder in patients with cryptogenic stroke: time schedule, reasons for explantation and incidental findings (results from the TRACK-AF trial)
Bettin, M., Dechering, D. G., Kochhäuser, S., Bode, N., Eckardt, L., Frommeyer, G., & Reinke, F. (2018) · Clinical Research in Cardiology · doi:10.1007/s00392-018-1358-4 · Cited by 21
Resource Use and Economic Implications of Remote Monitoring With Subcutaneous Cardiac Rhythm Monitors
Afzal, M. R., Nadkarni, A., Niemet, L., Houmsse, M. M., Devgun, J. K., Koppert, T. L., Ferguson, K., Mease, J., Okabe, T., Houmsse, M., et al. (2021) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2020.10.014 · Cited by 21
New Developments in Cardiac Pacemakers
Vardas, P. E., SIMANTIRAKIS, E. N., & KANOUPAKIS, E. M. (2013) · Circulation · doi:10.1161/circulationaha.112.000086 · Cited by 21

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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