1. Initial heart rate score predicts new-onset atrial tachyarrhythmias in pacemaker patients.
- Author
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Hayashi K, Abe H, Olshansky B, Sharma AD, Jones PW, Wold N, Perschbacher D, Kohno R, Richards M, and Wilkoff BL
- Subjects
- Humans, Heart Rate physiology, Heart Atria, Tachycardia diagnosis, Tachycardia epidemiology, Cardiac Pacing, Artificial adverse effects, Cardiac Pacing, Artificial methods, Pacemaker, Artificial adverse effects, Atrial Fibrillation diagnosis, Atrial Fibrillation epidemiology, Atrial Fibrillation etiology
- Abstract
Aims: Heart rate score (HRSc), the per cent of atrial paced and sensed event in the largest 10 b.p.m. rate histogram bin of a pacemaker, predicts survival in patients with cardiac devices. No correlation between HRSc and development of atrial fibrillation (AF) has been reported. In this study, we evaluated the relationship between pacemaker post-implantation HRSc and the incidence of newly developed atrial tachyarrhythmias (ATAs)., Methods and Results: Patients with dual-chamber pacemakers, implanted 2013-17, with the LATITUDE remote monitoring data with ≥600 000 beats of histogram data collected at baseline were included (N = 34 543). Heart rate score was determined from the initial 3-month post-implantation histogram data. Patients were excluded if they had ATAs, defined as atrial high-rate episodes >5 min or >1% of right atrial beats >170 b.p.m. during the initial 3 months post-implantation. New ATAs, after the baseline period, were defined by each of the following: >1, >10, or >25% of atrial beats >170 b.p.m. or atrial tachycardia response (ATR) events >24 h. Patients were followed a median of 2.8 (1.0-4.0) years. The incidence of ATAs increased in proportion to HRSc (log-rank P-value <0.001), and the initial HRSc ≥70% was associated with increased ATAs by all definitions. Patients with initial HRSc ≥70% were older, had a higher percentage of right atrium pacing (%RA pacing), had a lower percentage of right ventricular pacing (%RV pacing), and were more likely programmed with rate-response vs. subjects with HRSc <70%. Initial HRSc (hazard ratio: 1.07, 95% confidence interval: 1.05-1.09; P < 0.0001) independently predicted ATAs after adjusting for age, gender, %RV pacing, and rate-response programming. The %RA pacing and initial HRSc were correlated., Conclusion: Heart rate score independently predicts any subsequent duration of ATAs in pacemaker patients., Competing Interests: Conflict of interest: K.H., R.K., and M.R. have nothing to declare. H.A. has received research grants from Boston Scientific, Medtronic, and Abbott. B.O. is member of a DSMB sponsored by AstraZeneca. A.D.S. has received consultant fees from VivaQuant and CardioSignal. P.W.J., N.W., and D.P. are salaried employees of Boston Scientific. B.L.W. has received consultant and speaker fees from Boston Scientific, Medtronic, Abbott, and Biotronik., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2023
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