Is the Atrial High Rate Episode Diagnostic Feature Reliahle in Detecting Paroxysmal Episodes of Atrial Tachyarrhythmias?

Abstract

The atrial high rate episode diagnostic in the Thera pacemaker reports frequency, duration, and date/time of atrial tachyarrhythmias according to programmed criteria. The aim of the study was to validate the atrial high rate episode diagnostic feature. Episodes of atrial fibrillation recorded by Holter monitoring were compared to episodes detected by the pacemaker. Forty five ambulatory (Holter) recordings were used for evaluation. Thirty of 45 ambulatory (Holter) recordings showed sinus rhythm. On 4 of these 30 ambulatory (Holter) recordings, the Thera detected 12 episodes of atrial tachyarrhythmias as false-positives (sinus rhythm was detected as atrial tachyarrhythmia). The main reason was far-field R and T was oversensing. On 15 of 45 ambulatory (Holter) recordings, 125 episodes of atrial tachyarrhythmias were recorded. Ninety-three of these events also were detected by the pacemaker, while for 32 events the Thera reported sinus rhythm. The main reason was that the episodes were of too short duration. Therefore, the Thera (programmed with detection rate 160 beats/min, detection beats 40, termination beats 10) was unable to detect atrial tachycardias. Software simulation of the diagnostic algorithm under several programming settings using the digitized Holter files demonstrated highly reliable detection of atrial tachyarrhythmias (sensitivity 98%, specificity 100%) when programmed as follows: detection rate 220 beats/min, detection beats 10, termination beats 20. It can be concluded that Thera's high rate episode monitor is a reliable tool for detection of atrial tachyarrhythmias, if programmed as recommended.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…963,964 These devices can also assess long-term AF burden, burden trends, and late or asymptomatic recurrences. 940,965,966 The ability to record intracardiac atrial electrograms provides excellent sensitivity and specificity for the diagnosis of atrial arrhythmias, especially with durations exceeding a few minutes.…”

Atrial High Rate Episodes Detected by Pacemaker Diagnostics Predict Death and Stroke

“…They reported that stored episodes digitally classified by the pacemaker as Ͼ250 beats per minute and Ͼ5 minutes in duration had a high correlation (88%) with the tachyarrhythmia validated by simultaneous stored intracardiac electrograms. With regards to actual electrocardiographic confirmation of arrhythmia, Seidel et al 7 compared Holter monitor recordings to pacemaker diagnostic reports. They concluded that optimal programming for reliable arrhythmia detection (98% sensitivity and 100% specificity) could be attained with exactly the same programming as pacemakers were programmed in our study: detection rate 220 beats per minute, onset number of beats 10, and termination number of beats 20.…”

“…The atrial detection rate was programmed to 220 bpm so as to include only episodes of atrial fibrillation and exclude slower atrial tachycardias. 7 The onset detection number of beats was 10 and the termination number was 20 consecutive beats at a rate below the detection rate, for the purpose of excluding short episodes of atrial premature beats. Intracardiac electrograms were not recorded in order to preserve pacemaker memory to register a greater number of events.…”

Value of implantable cardioverter-defibrillators in managing atrial fibrillation

“…Importantly, device-derived atrial high rate episodes correlate with true AF diagnosis. 18, 19 In one study, 38% of patients with a history of AF had episodes of AF lasting more than 48 hours noted at the time of interrogation despite these patients being asymptomatic and in sinus rhythm at the time of evaluation. 20 In patients receiving pacemakers for sinus node dysfunction up to 68% may have device-documented AF over time.…”