High Rate Atrial Tachyarrhythmia Detections in Implantable Pulse Generators: Low Incidence of False-Positive Detections

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Abstract
Some newer pulse generators have enhanced diagnostic features that provide information on the frequency, date, time of onset, and duration of atrial and/or ventricular tachyarrhythmias. However, the sensitivity and specificity of device-based atrial tachyarrhythmia detections may vary and depend, in part, on lead position and selected programming parameters. The prevalence of inappropriate detections of paroxysmal atrial fibrillation (PAF) was investigated in 97 patients who received a Thera DR pacemaker 3 months prior to a planned AV node ablation. Patients were randomized to no atrial or to rate adaptive atrial pacing therapy and followed for 3 months. Following a total AV node ablation, patients were randomized to DDDR versus VDD pacing and followed for 1 year. The high rate atrial episode diagnostic feature was used for detection of PAF and the diagnostic data were retrieved during follow-up visits. Criteria were developed to identify oversensing due to near-field P wave detections, far-field R wave detections, or competitive atrial pacing as causes of false-positive atrial tachyarrhythmia detections. A total of 1,636 detections of PAF were recorded in patients preablation. Only 48 episodes (2.9%) were characterized as false-positive detections; 25 episodes (1.5%) were classified as oversensing, and 23 episodes (1.4%) were classified as competitive atrial pacing. A total of 3,061 detections of PAF were recorded postablation. Only four episodes (0.1%) were classified as oversensing. Thus, the diagnostic atrial tachyarrhythmia detection feature in newer pacemakers is an effective method for evaluating the time course of PAF in patients with implantable pulse generators.