Clinical significance of pacemaker-detected atrial high-rate episodes

Current Opinion in Cardiology

Volumn 23, Issue 1, 2008, Pages 60-64

  Mandava, Anisha ^a   Mittal, Suneet ^a,b  

^a Columbia University College of Physicians and Surgeons ^*  (United States)

^b ST LUKE S ROOSEVELT HOSPITAL CENTER   (United States)

Author keywords

Atrial fibrillation; Atrial high rate episodes; Permanent pacemakers

Indexed keywords

CARDIOVASCULAR RISK; DECISION MAKING; FOLLOW UP; HEART ATRIUM FIBRILLATION; HEART ATRIUM PACEMAKER; HEART PACING; PRIORITY JOURNAL; REVIEW; RISK FACTOR; STROKE;

ATRIAL FIBRILLATION; EARLY DIAGNOSIS; HUMANS; PACEMAKER, ARTIFICIAL;

EID: 40349097944     PISSN: 02684705     EISSN: None     Source Type: Journal    
DOI: 10.1097/HCO.0b013e3282f20a88     Document Type: Review

References (30)

1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults. National implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA 2001; 285:2370-2375.
2. Chugh SS, Blackshear JL, Shen WK, et al. Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol 2001; 37:371-378.
3. Paciaroni M, Agnelli G, Caso V, et al. Atrial fibrillation in patients with first ever stroke; frequency, antithrombotic treatment before the event and effect on clinical outcome. J Thromb Haemost 2005; 3:1218-1223.
4. Dries DL, Exner DV, Gersh BJ, et al. Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular dysfunction: a retrospective analysis of SOLVD trial. J Am Coll Cardiol 1998; 32:695-703.
5. Centers for Disease Control and Prevention. Public health and aging: atrial fibrillation as a contributing cause of death and Medicare hospitalization - United States, 1999. Morb Mortal Wkly Rep MMWR 2003; 52:128-131.
6. Benjamin EJ, Wolf PA, D'Agostino RB, et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart study. Circulation 1998; 98:946-952.
7. Page RL, Wilkinson WE, Clair WK, et al. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation 1994; 89:224-227.
8. Rho RW, Page RL. Asymptomatic atrial fibrillation. Progr Cardiovasc Dis 2005; 48:79-89.
9. Santini M, Alexidou G, Ansalone G, et al. Relation of prognosis in sick sinus syndrome to age, conduction defects and modes of permanent cardiac pacing. Am J Cardiol 1990; 65:729-735.
10. Andersen HR, Thuesen L, Bagger JP, et al. Prospective randomized trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet 1994; 344:1523-1528.
11. Andersen HR, Nielsen JC, Thomsen PEB, et al. Long-term follow-up of patients from a randomized trial of atrial versus ventricular pacing for sicksinus syndrome. Lancet 1997; 350:1210-1216.
12. Stambler BS, Ellenbogen KA, Orav EJ, et al. Predictors and clinical impact of atrial fibrillation after pacemaker implantation in elderly patients treated with dual chamber versus ventricular pacing. PACE 2003; 26:2000-2007.
13. Skanes AC, Krahn AD, Yee R, et al. Progression to chronic atrial fibrillation after pacing: the Canadian trial of physiologic pacing. J Am Coll Cardiol 2001; 38:167-172.
14. Connolly SJ, Kerr CR, Gent M, et al. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. N Engl J Med 2000; 342:1385-1391.
15. Kristensen L, Nielsen JC, Mortensen PT, et al. Incidence of atrial fibrillation and thromboembolism in a randomized trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome. Heart 2004; 90:661-666.
16. Seidl K, Meisel E, Vanaght E, et al. Is the atrial high rate episode diagnostic feature reliable in detecting paroxysmal episodes of atrial tachyarrhythmias? PACE 1998; 21:694-700.
17. Pollak WM, Simmons JD, Interian A Jr, et al. Clinical utility of intraatrial pacemaker stored electrograms to diagnose atrial fibrillation and flutter. PACE 2001; 24:424-429.
18. Cheung JW, Keating RJ, Stein KM, et al. Newly detected atrial fibrillation following dual chamber pacemaker implantation. J Cardiovasc Electrophysiol 2006; 17:1323-1328. This is one of the first studies to report on the incidence of AHREs observed after dual-chamber pacemaker implantation with no known history of atrial fibrillation. High-rate episodes were observed in 30% of patients. In patients with sinus node dysfunction, 50% or more cumulative right ventricular apical pacing doubled the risk of developing a high-rate episode.
19. Orlov MV, Ghali JK, Araghi-niknam M, et al., for the Atrial High Rate Trial Investigators. Asymptomatic atrial fibrillation in pacemaker recipients: incidence, progression, and determinants based on the Atrial High Rate Trial. PACE 2007; 30:404-411. This study showed that the vast majority of AHREs are asymptomatic.
20. Ghali JK, Orlov MV, Araghi-Niknam M, et al. The influence of symptoms and device detected atrial tachyarrhythmias on medical management: insights from A-HIRATE. PACE 2007; 30:850-857. This study showed that the detection of AHREs favorably influences the decision to initiate anticoagulation in these patients.
21. Lamas GA, Lee K, Sweeney M, et al. Ventricular pacing or dual-chamber pacing for sinus node-dysfunction. N Engl J Med 2002; 346:1854-1862.
22. Glotzer TV, Hellkamp AS, Zimmerman J, et al. 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). Circulation 2003; 107:1614-1619.
23. Defaye P, Dournaux F, Mouton E, et al., for the AIDA Multicenter Study Group. Prevalence of supraventricular arrhythmias from the automated analysis of data in the DDD pacemakers of 617 patients: the AIDA study. PACE 1998;21:250-255.
24. Gillis AM, Morck M. Atrial fibrillation after DDDR pacemaker implantation. J Cardiovasc Electrophysiol 2002; 13:542-547.
25. Schuchert A, Lepage S, Ostrander JJ, et al. Automatic analysis of pacemaker diagnostic data in the identification of atrial tachyarrhythmias in patients with no prior history of them. Europace 2005; 7:242-247.
26. Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003; 107:2932-2937.
27. Glotzer TV, Daoud EG, Wyse DG, et al. Rationale and design of a prospective study of the clinical significance of atrial arrhythmias detected by implanted device diagnostics: the TRENDS study. J Interv Card Electrophysiol 2006; 15:9-14. This study will determine whether the 30-day burden of atrial fibrillation (as assessed by pacemaker-detected AHREs) is an independent predictor of the occurrence of an ischemic stroke. The results will probably help clarify the role of anticoagulation in these patients.
28. Hohnloser SH, Capuci A, Fain E, et al. Asymptomatic atrial fibrillation and stroke evaluation in pacemaker patients and the atrial fibrillation reduction atrial pacing trial (ASSERT). Am Heart J 2006; 152:442-447. This study is designed to determine whether the detection of AHREs (in patients with no known history of atrial fibrillation) predicts an increased risk of stroke and systemic thromboembolism. In addition, the study will investigate whether the routine application of an atrial overdrive pacing algorithm will reduce the incidence of symptomatic atrial fibrillation in these patients.
29. O'Donnell M, Oczkowski W, Fang J, et al. Preadmission antithrombotic treatment and stroke severity in patients with atrial fibrillation and acute ischemic stroke: an observational study. Lancet Neurol 2006; 5:749-754.
30. Deplanque D, Leys D, Parnetti L, et al. Stroke prevention and atrial fibrillation: reasons leading to an inappropriate management. Main results of the SAFE II study. Br J Clin Pharmacol 2004; 57:798-806.