Volume 9, Issue 1, Pages (January 2012)

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Date of download: 6/1/2016 Copyright © The American College of Cardiology. All rights reserved. From: Inappropriate Implantable Cardioverter-Defibrillator.

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Volume 9, Issue 1, Pages 24-31 (January 2012) The impact of atrial fibrillation with rapid ventricular rates and device programming on shocks in 106,513 ICD and CRT-D patients Avi Fischer, MD, FHRS, Kevin T. Ousdigian, MS, James W. Johnson, MS, Jeffrey M. Gillberg, MS, Bruce L. Wilkoff, MD, FHRS Heart Rhythm Volume 9, Issue 1, Pages 24-31 (January 2012) DOI: 10.1016/j.hrthm.2011.08.005 Copyright © 2012 Heart Rhythm Society Terms and Conditions

Figure 1 AF diagnostics include the daily AF burden and the ventricular rate. The dot plots the average ventricular rate during AF on a specific day. The time from the first day of AF duration of ≥1 hour and average ventricular rate of ≥110 bpm to the first all-cause shock was computed and used to generate the time course to first all-cause shock in Figure 6. AF = atrial fibrillation; RVR = rapid ventricular rate. Heart Rhythm 2012 9, 24-31DOI: (10.1016/j.hrthm.2011.08.005) Copyright © 2012 Heart Rhythm Society Terms and Conditions

Figure 2 Average ventricular rates during AF. N = 33,316 patients with at least 1 day with AF ≥ 1 hour. A: Histogram showing the percentage of patients with AF in each ventricular rate range. B: Inverse cumulative distribution of ventricular rates during AF. AF = atrial fibrillation. Heart Rhythm 2012 9, 24-31DOI: (10.1016/j.hrthm.2011.08.005) Copyright © 2012 Heart Rhythm Society Terms and Conditions

Figure 3 ICD programming parameters evaluated. N = 106,513 patients. ATP = antitachycardia pacing; ICD = implantable cardioverter defibrillator; RVR = rapid ventricular rate; SVT = supraventricular tachycardia; VF = ventricular fibrillation; VT = ventricular tachycardia. Heart Rhythm 2012 9, 24-31DOI: (10.1016/j.hrthm.2011.08.005) Copyright © 2012 Heart Rhythm Society Terms and Conditions

Figure 4 Hazard ratios for the risk of receiving an ICD shock, N = 106,513 patients of which 22,062 patients (21%) received 82,396 shocked episodes. A: All-cause shocked episodes per 100 patient-years. Rate ratios and 95% confidence intervals are graphed for all variables. B: Time from implant to first all-cause shock: Hazard ratios and 95% confidence intervals are graphed for all variables. AF = Atrial fibrillation; ATP = antitachycardia pacing; RVR = rapid ventricular rate; SVT = supraventricular tachycardia; VF NID = number of intervals to detect ventricular fibrillation. Heart Rhythm 2012 9, 24-31DOI: (10.1016/j.hrthm.2011.08.005) Copyright © 2012 Heart Rhythm Society Terms and Conditions

Figure 5 Effect of detection threshold and AF ± RVR on all-cause shocked episodes per 100 patient-years. VF NID = 18/24, SVT discriminators, and ATP for FVTs ON throughout follow-up. N = 40,289 patients. AF = atrial fibrillation; ATP = antitachycardia pacing; FVTs = “fast” ventricular tachycardias; RVR = rapid ventricular rate; SVT = supraventricular tachycardia; VF NID = number of intervals to detect ventricular fibrillation. Heart Rhythm 2012 9, 24-31DOI: (10.1016/j.hrthm.2011.08.005) Copyright © 2012 Heart Rhythm Society Terms and Conditions

Figure 6 Time course to first all-cause shock. Time 0: AF + RVR: first day with AF duration of ≥1 hour and average ventricular rate of ≥110 bpm, AF − RVR: first day with AF duration of ≥1 hour, no/little AF: matched start dates from implant to the start of dates of the AF + RVR and AF − RVR curves. AF = atrial fibrillation; RVR = rapid ventricular rate. Heart Rhythm 2012 9, 24-31DOI: (10.1016/j.hrthm.2011.08.005) Copyright © 2012 Heart Rhythm Society Terms and Conditions