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

Elizabeth S Kaufman1, Carsten W Israel, Girish M Nair

  • 1Heart and Vascular Research Center, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio 44109, USA. ekaufman@metrohealth.org

Heart Rhythm
|March 24, 2012
PubMed

Insights

Pacemaker atrial high-rate episodes (AHREs) can be falsely positive. Increasing AHRE duration significantly improves accuracy, reducing false positives and the need for physician review, especially for longer episodes.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Electrophysiology

Background:

  • Pacemakers automatically detect atrial high-rate episodes (AHREs).
  • While many AHREs indicate true atrial tachyarrhythmia/atrial fibrillation (AT/AF), a significant portion are false positives.
  • Accurate AHRE identification is critical as they can trigger oral anticoagulation therapy.

Purpose of the Study:

  • To evaluate the positive predictive value (PPV) of AHREs for electrogram-confirmed AT/AF.
  • To assess how varying atrial rates and episode durations impact AHRE accuracy.

Main Methods:

  • Analysis of 5769 AHREs from 2580 patients in the ASymptomatic atrial fibrillation and Stroke Evaluation in pacemaker patients and the AF Reduction atrial pacing Trial.
  • AHREs were reviewed for true AT/AF confirmation using electrograms.
  • PPV was assessed for episode durations of 6 minutes to 24 hours and atrial rates of 190 and 250 beats/min.

Main Results:

  • At a threshold of >6 minutes and >190 beats/min, 17.3% of AHREs were false positives, often due to ventriculoatrial synchrony.
  • Increasing the AHRE duration threshold significantly reduced false positives: 6.8% at 30 minutes, 3.3% at 6 hours, and 1.8% at 24 hours.
  • Raising the heart rate threshold to 250 beats/min offered minimal improvement in PPV with longer episode durations.

Conclusions:

  • A >6-minute, >190 beats/min AHRE threshold yields a 17.3% false positive rate, necessitating electrogram review by physicians.
  • Extending the AHRE duration threshold to >6 hours reduces the false positive rate to 3.3%, making physician review less critical for diagnosis.
Abstract

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