Incidence of documented atrial arrhythmias in patients with dual chamber cardiac implantable devices

Abstract

Atrial fibrillation (AF) is the most common sustained atrial arrhythmia, and is associated with increased risks of morbidity and mortality. Integrated management including anticoagulation therapy in patients with AF is increasingly recognized, but there are still a substantial number of AF patients admitted with stroke, heart failure, and other complications. This can be to some extent due to asymptomatic nature of AF as approximately one-third of patients did not report any symptoms commonly attributable to AF (e.g., palpitations, shortness of breath, or chest pain), leading to a prolonged delay in AF diagnosis and timely initiation of anticoagulation therapy. In many cases, asymptomatic AF is diagnosed only after the onset of complications such as ischemic stroke or congestive heart failure has occurred. Subclinical and asymptomatic atrial tachyarrhythmias often precede the development of clinical AF, and can be detected by continuous cardiac monitoring technology including cardiac implantable electronic devices (CIEDs, e.g., permanent pacemakers, implantable cardioverter defibrillators [ICD], and cardiac resynchronization therapy [CRT] devices). Previous studies demonstrated that atrial high rate episodes (AHREs) detected by CIEDs have a high correlation with clinically documented AF, and are independently associa