Clinical Implications of Brief Device-Detected Atrial Tachyarrhythmias in a Cardiac Rhythm Management Device Population: Results from the Registry of Atrial Tachycardia and Atrial Fibrillation Episodes

Steven Swiryn, Michael V. Orlov, David G. Benditt, John P. Dimarco, Donald M. Lloyd-Jones, Edward Karst, Fujian Qu, Mara T. Slawsky, Melanie Turkel, Albert L. Waldo

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95 Scopus citations

Abstract

Background: The RATE Registry (Registry of Atrial Tachycardia and Atrial Fibrillation Episodes) is a prospective, outcomes-oriented registry designed to document the prevalence of atrial tachycardia and/or fibrillation (AT/AF) of any duration in patients with pacemakers and implantable cardioverter defibrillators (ICDs) and evaluate associations between rigorously adjudicated AT/AF and predefined clinical events, including stroke. The appropriate clinical response to brief episodes of AT/AF remains unclear. Methods: Rigorously adjudicated electrogram (EGM) data were correlated with adjudicated clinical events with logistic regression and Cox models. Long episodes of AT/AF were defined as episodes in which the onset and/or offset of AT/AF was not present within a single EGM recording. Short episodes of AT/AF were defined as episodes in which both the onset and offset of AT/AF were present within a single EGM recording. Results: We enrolled 5379 patients with pacemakers (N=3141) or ICDs (N=2238) at 225 US sites (median follow-up 22.9 months). There were 359 deaths. There were 478 hospitalizations among 342 patients for clinical events. We adjudicated 37 531 EGMs; 50% of patients had at least one episode of AT/AF. Patients with clinical events were more likely than those without to have long AT/AF (31.9% vs. 22.1% for pacemaker patients and 28.7% vs. 20.2% for ICD patients; P<0.05 for both groups). Only short episodes of AT/AF were documented in 9% of pacemaker patients and 16% of ICD patients. Patients with clinical events were no more likely than those without to have short AT/AF (5.1% vs. 7.9% for pacemaker patients and 11.5% vs. 10.4% for ICD patients; P=0.21 and 0.66, respectively). Conclusions: In the RATE Registry, rigorously adjudicated short episodes of AT/AF, as defined, were not associated with increased risk of clinical events compared with patients without documented AT/AF. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00837798.

Original languageEnglish (US)
Pages (from-to)1130-1140
Number of pages11
JournalCirculation
Volume134
Issue number16
DOIs
StatePublished - Oct 18 2016

Bibliographical note

Funding Information:
Sources of Funding The RATE Registry was funded by St. Jude Medical. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and the paper's final contents.

Publisher Copyright:
© 2016 American Heart Association, Inc.

Keywords

  • anti-coagulation
  • atrial fibrillation
  • defibrillators
  • pacemakers
  • stroke
  • trials

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