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Volume 9, Issue 1, Pages (January 2012)

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1 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 (January 2012) DOI: /j.hrthm Copyright © 2012 Heart Rhythm Society Terms and Conditions

2 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: ( /j.hrthm ) Copyright © 2012 Heart Rhythm Society Terms and Conditions

3 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: ( /j.hrthm ) Copyright © 2012 Heart Rhythm Society Terms and Conditions

4 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: ( /j.hrthm ) Copyright © 2012 Heart Rhythm Society Terms and Conditions

5 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: ( /j.hrthm ) Copyright © 2012 Heart Rhythm Society Terms and Conditions

6 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: ( /j.hrthm ) Copyright © 2012 Heart Rhythm Society Terms and Conditions

7 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: ( /j.hrthm ) Copyright © 2012 Heart Rhythm Society Terms and Conditions


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