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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BackgroundInfluential
A Clinical Perspective on Atrial Fibrillation
Platonov, P. G., & Corino, V. (2018) · Series in bioengineering · doi:10.1007/978-3-319-68515-1_1 · Cited by 7
The Effects of Ranolazine on Paroxysmal Atrial Fibrillation in Patients with Coronary Artery Disease: A Preliminary Observational Study.
Leftheriotis, D. I., Flevari, P., THEODORAKIS, G. N., Rigopoulos, A. G., Ikonomidis, I., Panou, F. K., Sourides, V., Simitsis, P., Giannakakis, G., Aidonidis, I., et al. (2014) · Europe PMC (PubMed Central) · doi:10.4022/jafib.940 · Cited by 7
The Importance of Arrhythmia Burden for Outcomes and Management Related to Catheter Ablation of Atrial Fibrillation
Sánchez-Somonte, P., Gül, E. E., & Verma, A. (2021) · Korean Circulation Journal · doi:10.4070/kcj.2021.0077 · Cited by 7
Automatic mode switching in atrial fibrillation.
Stabile, G., Simone, A. D., & Romano, E. (2005) · PubMed · Cited by 7
Utility of extended cardiac monitoring to detect atrial fibrillation in patients with severe obstructive sleep apnea
Chanda, A., Wolff, A., McPherson, C. A., & Kwon, J. S. (2014) · Sleep And Breathing · doi:10.1007/s11325-014-0997-6 · Cited by 7
Persistent Atrial Fibrillation is Associated with a Poor Prognosis in Patients with Atrioventricular Block and Dual‐Chamber Pacemaker
Petrač, D., Radeljić, V., Delić-Brkljačić, D., Manola, Š., Bogdan, G. C., & Pavlović, N. (2012) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2012.03376.x · Cited by 7
Strategies for prediction and early detection of atrial fibrillation: present and future
García-Fernández, A., Roldán, V., & Marín, F. R. (2016) · EP Europace · doi:10.1093/europace/euw131 · Cited by 7
“It has been shown that AHRE are associated with subsequent AF.(5) In addition, a relationship between AHRE and the incidence of thromboembolism and other complications has been demonstrated.”
BackgroundInfluential
Atrial Fibrillation
Waldo, A. L., & Camm, A. J. (2017) · Circulation · doi:10.1161/circulationaha.117.030705 · Cited by 7
Smartwatches in the Fight Against Atrial Fibrillation
Mela, T. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.03.485 · Cited by 7
Novel Technologies in the Detection of Atrial Fibrillation: Review of Literature and Comparison of Different Novel Technologies for Screening of Atrial Fibrillation
Santala, O. E., Lipponen, J. A., Jäntti, H., Rissanen, T. T., Tarvainen, M. P., Väliaho, E., Rantula, O., Naukkarinen, N. S., Hartikainen, J. E. K., Martikainen, T. J., et al. (2023) · Cardiology in Review · doi:10.1097/crd.0000000000000526 · Cited by 10
“99,100 According to a survey conducted by Singer et al, 101 the risk of ischemic stroke in patients with cardiac implantable electronic devices and continuous rhythm monitoring was greatest within 5 days and decreased rapidly thereafter an AF period of 5.5 hours or longer.”
MethodInfluential
Clinical significance of pacemaker-detected atrial high-rate episodes
Mandava, A., & Mittal, S. (2008) · Current Opinion in Cardiology · doi:10.1097/hco.0b013e3282f20a88 · Cited by 6
Performance of atrial tachyarrhythmia-sensing algorithms in dual-chamber pacing using a fixed long AV delay in patients with sinus node dysfunction
Pakarinen, S., & Toivonen, L. K. (2012) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-012-9691-4 · Cited by 6
Everything Counts in Large Amounts
Viles-González, J. F., & Halperin, J. L. (2009) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.109.909101 · Cited by 6
Paroxysmal Atrial Fibrillation: Novel Strategies for Monitoring and Implications for Treatment in Stroke
Silverman, S. B. (2016) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-016-0475-5 · Cited by 6
Monitoring Atrial Fibrillation After Catheter Ablation.
Forleo, G. B., Casella, M., Russo, A. D., Moltrasio, M., Fassini, G., Tesauro, M., & Tondo, C. (2014) · PubMed Central · doi:10.4022/jafib.1040 · Cited by 6
Detection of Previously Unrecognized (Subclinical) Atrial Fibrillation
Kochav, S. M., & Reiffel, J. A. (2020) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2020.04.013 · Cited by 6
Use of Oral Anticoagulation in a Real‐World Population With Device Detected Atrial Fibrillation
Kaplan, R. M., Ziegler, P., Koehler, J. L., Landman, S. R., Sarkar, S., & PASSMAN, R. S. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.018378 · Cited by 6
The evaluation of pulmonary vein isolation and wide-area left atrial ablation to treat atrial fibrillation in patients with implanted permanent pacemakers: the Previously Paced Pulmonary Vein Isolation Study
Veasey, R. A., Silberbauer, J., SCHILLING, R. J., Morgan, J. M., Paul, V. E., FURNISS, S. S., & Sulke, N. (2010) · Heart · doi:10.1136/hrt.2009.188425 · Cited by 6
“The importance of device-derived AF episodes should not be underestimated. The presence of AF episodes as short as 5 min has been reported to be a powerful independent predictor of stroke, death and persistent AF.”
Background
Cardiovascular Disease in the Oldest Old: A Geriatric Epidemiology Perspective
Bari, M. D., & Balzi, D. (2017) · Springer eBooks · doi:10.1007/978-3-319-43468-1_2 · Cited by 6
Monitoring capabilities of cardiac rhythm management devices
Andrikopoulos, G., Tzeis, S., Theodorakis, G., & Vardas, P. (2010) · Europace · doi:10.1093/europace/eup317 · Cited by 5
Detection of atrial tachyarrhythmias in an implantable monitoring device
Abe, H. (2012) · Journal of Arrhythmia · doi:10.1016/j.joa.2012.02.004 · Cited by 5
Relationship between predictive factors and atrial high-rate episodes in heart failure with reduced ejection fraction patients with cardiac implantable electronic devices
Karaaslan, Ö. Ç., Şahan, E., Karanfil, M., & Güray, Ü. (2024) · Acta cardiologica. Supplementum · doi:10.1080/00015385.2024.2443295 · Cited by 5
Is competitive atrial pacing a possible trigger for atrial fibrillation? Observations from the RATE registry
Orlov, M. V., Olshansky, B., Benditt, D. G., Kotler, G., McIntyre, T., Qu, F., Turkel, M., Gorev, M. V., Poghosyan, H., & Waldo, A. L. (2020) · Heart Rhythm · doi:10.1016/j.hrthm.2020.07.028 · Cited by 5
Predicting stroke events with a proactive fusion system: a comprehensive study on imbalance class handling in computational biomechanics
Ameksa, M., Elassad, Z. E. A., Lamjadli, S., & Mousannif, H. (2024) · Computer Methods in Biomechanics & Biomedical Engineering · doi:10.1080/10255842.2024.2363946 · Cited by 5
“According to World Health Organization (WHO), strokes are defined as an acute, global disturbance or dysfunctions of the blood vessels supplying the causes of limb paralysis, severe morbidity, and unconsciousness (van Gijn and Rinkel 2001).”
Direct oral anticoagulants for stroke prevention in patients with device-detected atrial fibrillation: assessing net clinical benefit
McIntyre, W. F., Benz, A. P., Tojaga, N., Brandes, A., Lópes, R. D., & Healey, J. S. (2024) · European Heart Journal Supplements · doi:10.1093/eurheartjsupp/suae075 · Cited by 5
“9,10,12 After early studies showed an association with ischaemic stroke or systemic embolism, the term ‘subclinical’ AF came into use.”
Background
Atrial High-Rate Episodes and Subclinical Atrial Fibrillation: State of the Art and Clinical Questions with Complex Solutions
Brookles, C. G., Ponti, R. D., Russo, V., Ziacchi, M., Pelargonio, G., Casella, M., Lauretti, M., Vilotta, M., Themistoclakis, S., D’Onofrio, A., et al. (2024) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2508305 · Cited by 5
“However, 38% of patients from Ancillary MOST [63] had previous supraventricular tachycardias.”
Background
Pacemaker Diagnostics in Atrial Fibrillation: Limited Usefulness for Therapy Initiation in a Pacemaker Practice
Yedlapati, N., & Fisher, J. D. (2014) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.12392 · Cited by 5
AF Detected on Implanted Cardiac Implantable Electronic Devices: Is There a Threshold for Thromboembolic Risk?
Baibars, M., Kanjwal, K., & Marine, J. E. (2014) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-013-0289-7 · Cited by 5
Atrial Fibrillation and Stroke: The Evolving Role of Rhythm Control
Patel, T. K., & PASSMAN, R. S. (2013) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-013-0234-9 · Cited by 5
“In addition, episodes of AF lasting only hours have been shown to be associated with increased stroke risk in several trials, signifying that even a moderate reduction in AF burden may not be enough to ameliorate the event rate [13–17].”
Background
Silent brain infarcts in high blood pressure patients with cardiac implantable electronic devices
Benezet‐Mazuecos, J., Iglesias, J. A., Cortés, M., de la Vieja, J. J., Campal, J. M. R., Sanchez-Borque, P., & Farré, J. (2015) · Journal of Hypertension · doi:10.1097/hjh.0000000000000787 · Cited by 5
“A substudy of the MOde Selection Trial reported that AHRE lasting at least 5 min predicted a higher incidence of the composite outcome of death and nonfatal stroke [11].”
Method
Diagnostic capabilities of devices for cardiac resynchronization therapy
Gardini, A., Lupo, P., Zanelli, E., Bisetti, S., & Cappato, R. (2010) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0b013e3283303036 · Cited by 5
When Silence Isn’t Golden: The Case of “Silent” Atrial Fibrillation
Reiffel, J. A. (2017) · Journal of Innovations in Cardiac Rhythm Management · doi:10.19102/icrm.2017.081102 · Cited by 5
Long-term rhythm monitoring with an implantable loop recorder in patients after the first clinical atrial fibrillation episode. Towards an individualized management
Papakonstantinou, P. Ε., & SIMANTIRAKIS, E. N. (2019) · Minerva Cardioangiologica · doi:10.23736/s0026-4725.19.04883-7 · Cited by 5
Proarrhythmic effects from competitive atrial pacing and potential programming solutions
Wass, S. Y., Kanj, M. H., Mayuga, K. A., Hussein, A. A., Saliba, W. I., Bhargava, M., Cantillon, D. J., TCHOU, P. J., Wazni, O. M., Wilkoff, B. L., et al. (2020) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13962 · Cited by 5
Remote Monitoring of Permanent Pacemakers and Implantable Cardioverter Defibrillators
Wilner, B. R., & Rickard, J. (2021) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2021.04.005 · Cited by 5
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. (2021) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2021-4420 · Cited by 7
Subcutaneouscardiac Rhythm Monitors: A Comprehensive Review
Lakkireddy, D. (2021) · Journal of Atrial Fibrillation · doi:10.4022/jafib.2387 · Cited by 5
Stroke risk in patients with device-detected atrial high-rate episodes
Erküner, Ö., Rienstra, M., Gelder, I. C. V., Schotten, U., Crijns, H. J. G. M., & LUERMANS, J. G. L. M. (2017) · Netherlands Heart Journal · doi:10.1007/s12471-017-1047-3 · Cited by 5
“In a subgroup analysis of the MOde Selection Trial (MOST) [16], 312 patients with a median age of 74 years were included, of whom 60% had a history of supraventricular arrhythmias.”
Method

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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