Tables Table 1: Incidence of CIED-detected atrial high rate episodes (AHREs) in the population with cardiac implanted devices Year Device Indication Clinical Profile of Patients Mean age % male LVEF% Mean CHADS2 Follow-up AF burden threshold Incidence of AF 2002 Gillis et al.8 PPMs for sinus node disease All 70 ± 12 52% N.A. N.A. 718 ± 383 days >1 min 157/231 (68%) 2003 Ancillary MOST 10 PPMs for node disease All Median 73 (68,81) for no AHRE Median 75 (68,79) for AHRE detected 45% N.A. N.A. Median 27 months >5 min 156/312 (50%) 2010 TRENDS15 PPMs and ICDs All indications History of prior stroke No history of AF No OAC use ≥1 stroke risk factor 72.8±9.9 for no AHRE 74.0±9.1 for AHRE detected 63% for no AHRE 71% for AHRE detected N.A. 4.1±0.8 for no AHRE 4.2±0.8 for AHRE detected Mean 1.4 years >5 min 45/163 (28%) 2012 TRENDS14 PPMs and ICDs All indications No history of prior stroke No history of AF No OAC use ≥1 stroke risk factor 70.2± 11.8 66% N.A. ≥2 in 70% 1.1 ± 0.7 years >5 min 416/1368 (30%)
2012 ASSERT11 PPMs and ICDs All indications History of hypertension No history of AF No OAC use 76±7 for no AHRE 77±7 for AHRE detected 59% for no AHRE 56% for AHRE detected N.A. 2.3±1.0 for no AHRE 2.2±1.1 for AHRE detected 2.5 years >6 min 895/2580 (34.7%) 2012 Home Monitor CRT17 CRTDs and CRTPs CHF Heart failure No history of AF 66 ±10 77% 25 (20–30) ≥2 in 64% 370 days (253-290) ≥14 min 126/560 (23%) 2013 Healey et al.12 PPMs All indications All 71.7 ±14.4 for no AHRE 74.3±13.7 for AHRE detected 59% for no AHRE 58% for AHRE detected N.A. 2.02± 1.30 for no AHRE 2.23±1.47 for AHRE detected Single center Retrospective >5 min 246/445 (55.3%) 2015 IMPACT18 ICDs and CRTDs All indications No permanent AF No for OAC 64.2+11.5 for Control 64.7+10.8 for Intervention 73% for Control 74% for Intervention 29.4+11.3 for Control 29.9+10.8 for Intervention 2 (median) 701 days >4-12 sec 945/2718 (34.8%) 2016 RATE Registry 13 PPMs and ICDs All No permanent AF, 73.6±11.8 for PPMs, 64.5±12.6 for ICDs 54% in PPM 72% in ICDs 57.8±10.5 for PPM 29.2±11.3 for ICDs 1.8±1.0 for PPM 2.0±0.8 for ICDs 22.9 months (median) > 3 atrial premature complexes 145/300(48%) of PPM pts 155/300 (52%) of ICD pts Of the representative samples studied
Microlife BPA 200 Algorithm only (based on pulse irregularity) 97 (81.4-100) 90 (83.8-94.2) Wiesel et al., 201461 Omron M6 Algorithm only on pulse irregularity) 100 94 Marazzi et al., 201260 Omron M6 comfort Algorithm only (based on pulse irregularity) 30 (15.4-49.1) 97 (92.5-99.2) Wiesel et al., 201461 Microlife WatchBP Algorithm only on pulse irregularity) 94.9 89.7 (87.5-91.6) Kearley et al., 201456 Plethysmographs Finger probe Algorithm only on pulse irregularity) 100 91.9 Lewis et al., 201162 iPhone Algorithm only (based on pulse irregularity) 97.0 93.5 ¶McManus et al., 201663 LEGEND: The comparator for all studies was 12-lead ECG (¶also used 3-lead telemetry).
Legend: BP = blood pressure; PPG = photoplethysmography; enrichment = use of additional risk factors or biomarkers to either increase the proportion with unknown AF in the screened population, or increase the risk of stroke in those with AF detected by screening in that population; patients who are undertreated = patients with known AF who are not receiving oral anticoagulant according to guidelines, (see Page XXX section on “Should screening include undertreated known AF”). While this is not strictly speaking screening, such patients will be detected by population screening for AF, so this has been placed in a different shape with a dotted line connector; ESUS = embolic stroke of uncertain source. COI Disclosure statements B Freedman reports speakers fees and advisory board honoraria from Bayer Pharma AG (significant), Boehringer Ingelheim (modest), BMS/Pfizer (significant). J Camm reports grants and personal fees from Bayer, Beorhinger Ingelheim and Daichi Sankyo, and personal fees from Pfizer/BMS. H Calkins reports a consultancy with BMS/Pfizer (modest), speaker fees (significant) from Boehringer Ingelheim, and speaker fees and a consultancy with Medtronic (significant). He has also participated in a multicenter trial supported by Boerhringer Ingelheim (significant) J Healey reports grants from Medtronic, grants from Bristol-Meyers-Squibb, grants from Bayer, grants from Boehringer-Ingelheim, outside the submitted work. M Rosenqvist reports grants (significant) and personal fees ( modetst) from Bayer, grants (significant) and personal ( modest) fees from Boehringer-Ingelheim, grants (significant) and personal fees ( modest) from BMS, grants and personal fees ( modest) from Pfizer, grants (modest) and personal fees ( modest)from Medtronic, grants (significant) and personal fees Significant) from St Jude Medical, grants and personal fees( modest) from Zenicor, personal fees (modest) from Sanofi, grants (significant) from Roche, outside the submitted work. J Wang has no disclosures. C Albert has no disclosures.