Document Detail

Detection of atrial high-rate events by continuous home monitoring: clinical significance in the heart failure-cardiac resynchronization therapy population.
MedLine Citation:
PMID:  21933802     Owner:  NLM     Status:  MEDLINE    
AIMS: Uncertainty exists over the importance of device-detected short-duration atrial arrhythmias. Continuous atrial diagnostics, through home monitoring (HM) technology (BIOTRONIK, Berlin, Germany), provides a unique opportunity to assess frequency and quantity of atrial fibrillation (AF) episodes defined as atrial high-rate events (AHRE).
METHODS AND RESULTS: Prospective data from 560 heart failure (HF) patients (age 67 ± 10 years, median ejection fraction 27%) patients with a cardiac resynchronization therapy (CRT) device capable of HM from two multi-centre studies were analysed. Atrial high-rate events burden was defined as the duration of mode switch in a 24-h period with atrial rates of >180 beats for at least 1% or total of 14 min per day. The primary endpoint was incidence of a thromboembolic (TE) event. Secondary endpoints were cardiovascular death, hospitalization because of AF, or worsening HF. Over a median 370-day follow-up AHRE occurred in 40% of patients with 11 (2%) patients developing TE complications and mortality rate of 4.3% (24 deaths, 16 with cardiovascular aetiology). Compared with patients without detected AHRE, patients with detected AHRE>3.8 h over a day were nine times more likely to develop TE complications (P= 0.006). The majority of patients (73%) did not show a temporal association with the detected atrial episode and their adverse event, with a mean interval of 46.7 ± 71.9 days (range 0-194) before the TE complication.
CONCLUSION: In a high-risk cohort of HF patients, device-detected atrial arrhythmias are associated with an increased incidence of TE events. A cut-off point of 3.8 h over 24 h was associated with significant increase in the event rate. Routine assessment of AHRE should be considered with other data when assessing stroke risk and considering anti-coagulation initiation and should also prompt the optimization of cardioprotective HF therapy in CRT patients.
Nesan Shanmugam; Annegret Boerdlein; Jochen Proff; Peter Ong; Oswaldo Valencia; Sebastian K G Maier; Wolfgang R Bauer; Vince Paul; Stefan Sack
Publication Detail:
Type:  Evaluation Studies; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2011-09-20
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  14     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-23     Completed Date:  2012-05-23     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  230-7     Citation Subset:  IM    
Department of Cardiology, St George's Healthcare NHS Trust, London, UK.
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MeSH Terms
Atrial Fibrillation / diet therapy*,  mortality*,  prevention & control
Cardiac Resynchronization Therapy
Cohort Studies
Electrocardiography, Ambulatory / statistics & numerical data*
Heart Failure / diagnosis,  mortality*,  prevention & control*
Home Care Services / statistics & numerical data*
Reproducibility of Results
Risk Assessment
Risk Factors
Sensitivity and Specificity
Survival Analysis
Survival Rate
Comment In:
Europace. 2012 Feb;14(2):157-8   [PMID:  21987342 ]

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