title: 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.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00837798.
authors.affiliation: From the Feinberg School of Medicine, Northwestern University, Chicago, IL (S.S., D.M.L.-J.; Tufts University School of Medicine, Boston, MA (M.V.O.); University of Minnesota Medical School, Minneapolis (D.G.B.); University of Virginia, Charlottesville (J.P.D.); St. Jude Medical, Sunnyvale, CA (E.K., F.Q., M.T.); Baystate Medical Center, Tufts University School of Medicine, Springfield, MA (M.T.S.); and Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH (A.L.W.). s-swiryn@northwestern.edu.
authors.forename: Steven
authors.initials: S
authors.lastname: Swiryn
authors.affiliation: From the Feinberg School of Medicine, Northwestern University, Chicago, IL (S.S., D.M.L.-J.; Tufts University School of Medicine, Boston, MA (M.V.O.); University of Minnesota Medical School, Minneapolis (D.G.B.); University of Virginia, Charlottesville (J.P.D.); St. Jude Medical, Sunnyvale, CA (E.K., F.Q., M.T.); Baystate Medical Center, Tufts University School of Medicine, Springfield, MA (M.T.S.); and Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH (A.L.W.).
authors.forename: Michael V
authors.initials: MV
authors.lastname: Orlov
authors.affiliation: From the Feinberg School of Medicine, Northwestern University, Chicago, IL (S.S., D.M.L.-J.; Tufts University School of Medicine, Boston, MA (M.V.O.); University of Minnesota Medical School, Minneapolis (D.G.B.); University of Virginia, Charlottesville (J.P.D.); St. Jude Medical, Sunnyvale, CA (E.K., F.Q., M.T.); Baystate Medical Center, Tufts University School of Medicine, Springfield, MA (M.T.S.); and Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH (A.L.W.).
authors.forename: David G
authors.initials: DG
authors.lastname: Benditt
authors.affiliation: From the Feinberg School of Medicine, Northwestern University, Chicago, IL (S.S., D.M.L.-J.; Tufts University School of Medicine, Boston, MA (M.V.O.); University of Minnesota Medical School, Minneapolis (D.G.B.); University of Virginia, Charlottesville (J.P.D.); St. Jude Medical, Sunnyvale, CA (E.K., F.Q., M.T.); Baystate Medical Center, Tufts University School of Medicine, Springfield, MA (M.T.S.); and Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH (A.L.W.).
authors.forename: John P
authors.initials: JP
authors.lastname: DiMarco
authors.affiliation: From the Feinberg School of Medicine, Northwestern University, Chicago, IL (S.S., D.M.L.-J.; Tufts University School of Medicine, Boston, MA (M.V.O.); University of Minnesota Medical School, Minneapolis (D.G.B.); University of Virginia, Charlottesville (J.P.D.); St. Jude Medical, Sunnyvale, CA (E.K., F.Q., M.T.); Baystate Medical Center, Tufts University School of Medicine, Springfield, MA (M.T.S.); and Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH (A.L.W.).
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
authors.affiliation: From the Feinberg School of Medicine, Northwestern University, Chicago, IL (S.S., D.M.L.-J.; Tufts University School of Medicine, Boston, MA (M.V.O.); University of Minnesota Medical School, Minneapolis (D.G.B.); University of Virginia, Charlottesville (J.P.D.); St. Jude Medical, Sunnyvale, CA (E.K., F.Q., M.T.); Baystate Medical Center, Tufts University School of Medicine, Springfield, MA (M.T.S.); and Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH (A.L.W.).
authors.forename: Edward
authors.initials: E
authors.lastname: Karst
authors.affiliation: From the Feinberg School of Medicine, Northwestern University, Chicago, IL (S.S., D.M.L.-J.; Tufts University School of Medicine, Boston, MA (M.V.O.); University of Minnesota Medical School, Minneapolis (D.G.B.); University of Virginia, Charlottesville (J.P.D.); St. Jude Medical, Sunnyvale, CA (E.K., F.Q., M.T.); Baystate Medical Center, Tufts University School of Medicine, Springfield, MA (M.T.S.); and Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH (A.L.W.).
authors.forename: Fujian
authors.initials: F
authors.lastname: Qu
authors.affiliation: From the Feinberg School of Medicine, Northwestern University, Chicago, IL (S.S., D.M.L.-J.; Tufts University School of Medicine, Boston, MA (M.V.O.); University of Minnesota Medical School, Minneapolis (D.G.B.); University of Virginia, Charlottesville (J.P.D.); St. Jude Medical, Sunnyvale, CA (E.K., F.Q., M.T.); Baystate Medical Center, Tufts University School of Medicine, Springfield, MA (M.T.S.); and Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH (A.L.W.).
authors.forename: Mara T
authors.initials: MT
authors.lastname: Slawsky
authors.affiliation: From the Feinberg School of Medicine, Northwestern University, Chicago, IL (S.S., D.M.L.-J.; Tufts University School of Medicine, Boston, MA (M.V.O.); University of Minnesota Medical School, Minneapolis (D.G.B.); University of Virginia, Charlottesville (J.P.D.); St. Jude Medical, Sunnyvale, CA (E.K., F.Q., M.T.); Baystate Medical Center, Tufts University School of Medicine, Springfield, MA (M.T.S.); and Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH (A.L.W.).
authors.forename: Melanie
authors.initials: M
authors.lastname: Turkel
authors.affiliation: From the Feinberg School of Medicine, Northwestern University, Chicago, IL (S.S., D.M.L.-J.; Tufts University School of Medicine, Boston, MA (M.V.O.); University of Minnesota Medical School, Minneapolis (D.G.B.); University of Virginia, Charlottesville (J.P.D.); St. Jude Medical, Sunnyvale, CA (E.K., F.Q., M.T.); Baystate Medical Center, Tufts University School of Medicine, Springfield, MA (M.T.S.); and Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH (A.L.W.).
authors.forename: Albert L
authors.initials: AL
authors.lastname: Waldo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016022:Case-Control Studies; D015897:Comorbidity; D017147:Defibrillators, Implantable; D019468:Disease Management; D018450:Disease Progression; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016017:Odds Ratio; D010138:Pacemaker, Artificial; D011159:Population Surveillance; D012042:Registries; D013610:Tachycardia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D014481:United States
keywords: anti-coagulation; atrial fibrillation; defibrillators; pacemakers; stroke; trials