Positive predictive value of device-detected atrial high-rate episodes at different rates and durations: An analysis from ASSERT

Research output: Contribution to journalJournal articleResearchpeer-review

  • Elizabeth S Kaufman
  • Carsten W Israel
  • Girish M Nair
  • Luciana Armaganijan
  • Syamkumar Divakaramenon
  • Georges H Mairesse
  • Axel Brandes
  • Eugene Crystal
  • Otto Costantini
  • Roopinder K Sandhu
  • Ratika Parkash
  • Stuart J Connolly
  • Stefan H Hohnloser
  • Jeff S Healey
  • ASSERT Steering Committee and Investigators

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BACKGROUND: Pacemakers can automatically identify and catalog atrial high-rate episodes (AHREs). While most AHREs represent true atrial tachyarrhythmia/atrial fibrillation (AT/AF), a review of stored electrograms suggests that a substantial proportion do not. As AHREs may lead to the initiation of oral anticoagulation, it is crucial to understand the relationship between AHREs and true AT/AF. OBJECTIVE: To compare the positive predictive value of AHREs for electrogram-confirmed AT/AF for various atrial rates and episode durations. METHODS: By using data from 2580 patients who participated in the ASymptomatic atrial fibrillation and Stroke Evaluation in pacemaker patients and the AF Reduction atrial pacing Trial, all AHREs >6 minutes and >190 beats/min with available electrograms were reviewed to determine whether they represented true AT/AF. The positive predictive value of these AHREs was assessed for episode durations of 6 minutes, 30 minutes, 6 hours, and 24 hours at atrial rates of 190 and 250 beats/min. RESULTS: Of 5769 AHREs >6 minutes and >190 beats/min, 82.7% were true AT/AF and 17.3% were false positives (predominantly due to repetitive non-re-entrant ventriculoatrial synchrony). False positives dropped to 6.8%, 3.3%, and 1.8% when the threshold duration was increased to 30 minutes, 6 hours, and 24 hours, respectively. Increasing the threshold heart rate to 250 beats/min added little to the positive predictive value when longer threshold durations were used. CONCLUSIONS: By using a cutoff of >6 minutes and >190 beats/min, the rate of false-positive AHREs is 17.3%, making physician review of electrograms essential. For AHREs lasting >6 hours, the rate of false positives is 3.3%, making physician review less crucial.
JournalHeart Rhythm
Issue number8
Pages (from-to)1241-6
Number of pages6
Publication statusPublished - 2012