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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)
Open accessAbstract
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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“Several studies have shown an increased risk of thromboembolic events in patients with atrial arrhythmias detected by device diagnostics.59,60”
From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [60]
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Bayes’ Syndrome and the Opportunities for Early Anticoagulation
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What to do with device‐detected atrial high‐rate episodes: Summary of the evidences
Mert, G. Ö., Kepez, A., Mert, K. U., & Görenek, B. (2021) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.14428 · Cited by 11
Paroxysmal Atrial Fibrillation in Cryptogenic Stroke: an Overlooked Explanation?
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Long-term monitoring to detect atrial fibrillation with the indwelling implantable cardiac monitors
Sanna, T. (2018) · International Journal of Stroke · doi:10.1177/1747493018790023 · Cited by 12
“4%.(10) Based on these observations, AHRE is often accepted as a surrogate for AF in the literature.”
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“However, even with atrial electrograms it is still not possible to differentiate exactly between AF, atrial flutter or atrial tachycardia, as the atrial lead only shows local atrial activity.”
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“Several studies have proved a good correlation between AHRE and AF, and some are already considering it a surrogate [41].”
BackgroundSignificance and Management Strategies for Patients with Asymptomatic Atrial Fibrillation.
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“The more time spent in paroxysmal AF each day is associated with higher risk of thromboembolism [77].”
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Stroke prevention in atrial fibrillation: Closing the gap
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“Recent studies have shown that atrial fibrillation (AF) is the most frequent tachyarrhythmia in patients with a permanent PM, occurring in up to 65% of patients with a PM for the treatment of SSS (2, 3).”
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Forecasting imminent atrial fibrillation in long-term electrocardiogram recordings
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Does asymptomatic atrial fibrillation exist?
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“89 In the TRENDS study (A Prospective Study of the Clinical Significance of Atrial Arrhythmias Detected by Implanted Device Diagnostics), a high burden of AHRE (defined as daily burden of ≥ 5.5 h in the preceding 30 ‐ day period) doubled the risk of thromboembolism.”
BackgroundInfluentialRemote Monitoring of Cardiovascular Implantable Electronic Devices: New Questions Raised
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Metadata
- 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)
- Venue
- Circulation
- Published
- 2003-04
- Volume
- 107
- Issue
- 12
- Pages
- 1614-1619
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- 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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