Positive predictive value of device-detected atrial high-rate episodes at different rates and durations

An analysis from ASSERT

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

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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.
OriginalsprogEngelsk
TidsskriftHeart Rhythm
Vol/bind9
Udgave nummer8
Sider (fra-til)1241-6
Antal sider6
ISSN1547-5271
DOI
StatusUdgivet - 2012

Fingeraftryk

Equipment and Supplies
Cardiac Electrophysiologic Techniques
Physicians

Citer dette

Kaufman, E. S., Israel, C. W., Nair, G. M., Armaganijan, L., Divakaramenon, S., Mairesse, G. H., ... ASSERT Steering Committee and Investigators (2012). Positive predictive value of device-detected atrial high-rate episodes at different rates and durations: An analysis from ASSERT. Heart Rhythm, 9(8), 1241-6. https://doi.org/10.1016/j.hrthm.2012.03.017
Kaufman, Elizabeth S ; Israel, Carsten W ; Nair, Girish M ; Armaganijan, Luciana ; Divakaramenon, Syamkumar ; Mairesse, Georges H ; Brandes, Axel ; Crystal, Eugene ; Costantini, Otto ; Sandhu, Roopinder K ; Parkash, Ratika ; Connolly, Stuart J ; Hohnloser, Stefan H ; Healey, Jeff S ; ASSERT Steering Committee and Investigators. / Positive predictive value of device-detected atrial high-rate episodes at different rates and durations : An analysis from ASSERT. I: Heart Rhythm. 2012 ; Bind 9, Nr. 8. s. 1241-6.
@article{5ff40806f1734f309292519b674131cf,
title = "Positive predictive value of device-detected atrial high-rate episodes at different rates and durations: An analysis from ASSERT",
abstract = "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.",
author = "Kaufman, {Elizabeth S} and Israel, {Carsten W} and Nair, {Girish M} and Luciana Armaganijan and Syamkumar Divakaramenon and Mairesse, {Georges H} and Axel Brandes and Eugene Crystal and Otto Costantini and Sandhu, {Roopinder K} and Ratika Parkash and Connolly, {Stuart J} and Hohnloser, {Stefan H} and Healey, {Jeff S} and {ASSERT Steering Committee and Investigators}",
note = "Copyright {\circledC} 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.",
year = "2012",
doi = "10.1016/j.hrthm.2012.03.017",
language = "English",
volume = "9",
pages = "1241--6",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "8",

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Kaufman, ES, Israel, CW, Nair, GM, Armaganijan, L, Divakaramenon, S, Mairesse, GH, Brandes, A, Crystal, E, Costantini, O, Sandhu, RK, Parkash, R, Connolly, SJ, Hohnloser, SH, Healey, JS & ASSERT Steering Committee and Investigators 2012, 'Positive predictive value of device-detected atrial high-rate episodes at different rates and durations: An analysis from ASSERT', Heart Rhythm, bind 9, nr. 8, s. 1241-6. https://doi.org/10.1016/j.hrthm.2012.03.017

Positive predictive value of device-detected atrial high-rate episodes at different rates and durations : An analysis from ASSERT. / Kaufman, Elizabeth S; Israel, Carsten W; Nair, Girish M; Armaganijan, Luciana; Divakaramenon, Syamkumar; Mairesse, Georges H; Brandes, Axel; Crystal, Eugene; Costantini, Otto; Sandhu, Roopinder K; Parkash, Ratika; Connolly, Stuart J; Hohnloser, Stefan H; Healey, Jeff S; ASSERT Steering Committee and Investigators.

I: Heart Rhythm, Bind 9, Nr. 8, 2012, s. 1241-6.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Positive predictive value of device-detected atrial high-rate episodes at different rates and durations

T2 - An analysis from ASSERT

AU - Kaufman, Elizabeth S

AU - Israel, Carsten W

AU - Nair, Girish M

AU - Armaganijan, Luciana

AU - Divakaramenon, Syamkumar

AU - Mairesse, Georges H

AU - Brandes, Axel

AU - Crystal, Eugene

AU - Costantini, Otto

AU - Sandhu, Roopinder K

AU - Parkash, Ratika

AU - Connolly, Stuart J

AU - Hohnloser, Stefan H

AU - Healey, Jeff S

AU - ASSERT Steering Committee and Investigators

N1 - Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

PY - 2012

Y1 - 2012

N2 - 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.

AB - 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.

U2 - 10.1016/j.hrthm.2012.03.017

DO - 10.1016/j.hrthm.2012.03.017

M3 - Journal article

VL - 9

SP - 1241

EP - 1246

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 8

ER -