Mean ventricular heart rate at atrial burden Documented by Craig Reister, Boston Scientific

Need From the 2012 physician survey: A parameter for the ventricular heart rate measured at atrial burden. Note that older devices may only provide rate during mode switch or devices offer to select between Atr. burden and Mode switch. Identified by IDCO working group: Atrial and ventricular rate during episodes

Design considerations Clinical need is the ability to compare rates outside atrial burden with rates during atrial burden. – Rates outside atrial burden already exist as: MDC_IDC_STAT_HEART_RATE_ATRIAL_[MMM] MDC_IDC_STAT_HEART_RATE_VENTRICULAR_[MMM] – Add min, mean, max rates during atrial burden as a statistic for simple comparison. Consider making 2 – atrial burden, mode switch – No, just one. The patient is in the same state regardless of how the device reacts to the clinical state. Therefore, there is no clinical value to differentiation.

Design considerations The simple comparison may not be enough granularity. The ability to compare the rates outside atrial burden to rates during an episode (most notably an atrial arrhythmia episode) is clinically relevant. – Add min, mean, max rates during an episode for more detailed comparison.

Proposed Change (Atrial Burden definition) Definition of Atrial Burden: – The amount of time spent in an atrial tachyarrhythmia.

Proposed Change (statistic) Add a single statistic for ventricular interval/rate during atrial burden. The statistic should include the capability to represent the minimum, mean, and max intervals. Should this be interval or rate? Existing, similar examples: STAT_HEART_RATE is a rate EPISODE_ATRIAL_INTERVAL_AT_DETECTION is an interval Use rate to keep all values in the STATs as rates and not mixed rates and intervals. Add the following MDC_IDC_STAT_AT_BURDEN_VENTRICULAR_RATE_[MMM]

Proposed Change (statistic) Definition of MDC_IDC_STAT_AT_BURDEN_VENTRICULAR_RATE_[MMM]: – The ventricular rate during atrial burden. This statistic can be during a mode switch or can be unrelated to a mode switch.

Proposed Change (episode) Add atrial and ventricular intervals during an episode. The intervals should include the capability to represent the minimum, mean, and max intervals. Add the following: MDC_IDC_EPISODE_ATRIAL_INTERVAL_[MMM] MDC_IDC_EPISODE_VENTRICULAR_INTERVAL_[MMM]

Proposed Change (episode) Definition for episode-related parameters: – MDC_IDC_EPISODE_ATRIAL_INTERVAL_[MMM] The atrial interval during the episode. – MDC_IDC_EPISODE_VENTRICULAR_INTERVAL_[MMM] The ventricular interval during the episode.

Open Questions None