Continuous long-term monitoring of atrial fibrillation (AF) and tachycardia (AT) is an unmet clinical need, which could be met with a chronically-implanted monitor. Improved therapeutic decisions based on accurate monitoring of parameters, such as daily AF/AT burden (hours/ day) may lead to improvements in clinical outcomes such as reduction in hospitalizations, symptoms, and strokes. This paper describes an AF/AT detector that detects AF as well as AT with an irregular ventricular response, and a supplementary AT detector for AT with more regular ventricular response. Seven databases with significant durations of AF, AT, and sinus rhythm were used to evaluate the performance of the detectors. All patient records with AF (N = 124) were detected by the AF/AT detector to have AF/AT burden with a mean, median, and 75 percentile of absolute error in burden detection of 8.8, 0, and 4 min, respectively. In patients having AF burden (ges 10 min), the AF/AT detector was found to have burden accuracy within 20% of true burden in 96% of patients. The specificity was 94%, defined as follows: in patient records without AF/AT (N = 174), the percentage with AF/AT burden les10 min in the 24-h recordings. The AF/AT detector underestimates AT burden, thus degrading performance, in patients with significant amounts of AT with more regular ventricular response. The supplementary AT detector reduces the underestimation of AT while overestimating burden in patients without a significant amount of AT. The detectors described here could be implemented in an implantable monitor for accurate long-term AF/AT monitoring.

Presently, most devices with atrial diagnostic and therapeutic features are implanted in patients for electrical treatment of bradyarrhythmias and ventricular tachyarrhythmias. The painless electrical strategies for prevention and termination of ATa have not demonstrated significant clinical effectiveness in the general population with ATa. The effectiveness of ATP in reducing burden may be significantly higher in a subgroup of patients with a high incidence of stable ATa, but this needs to be evaluated prospectively. Smart sensing and detection schemes will also help provide accurate information and determine when ATa can be terminated with ATP. Although electrical defibrillation is effective, the discomfort associated with atrial shocks has limited the widespread use of this technology. Recent technological advances have increased the capabilities of implantable devices to store large amounts of diagnostic information. In the near future, implantable devices without transvenous leads may be implanted to monitor a variety of physiologic signals. This could help improve clinical outcomes and determine which therapies (pharmacologic, ablative, or electrical) would be most effective as well as monitor their safety and efficacy. Frequent monitoring from home and the availability of this data to the physician/nurse on the Internet can potentially improve the management of patients' ATa at a much lower cost.

The prevalence of cardiovascular diseases such as atrial tachyarrhythmias (ATa) has become prevalent worldwide. A discussion on the detection, monitoring, termination, and prevention of ATa is presented. Rhythm control is defined as maintenance of sinus rhythm. One measure of rhythm control is the percent of time spent in atrial tachyarrhythmias, commonly referred to as ATa burden. Rhythm control can be attempted with antiarrhythmic drugs, atrial ablation, or implantable devices. This paper gives attention to the management of ATa using implantable devices. Such devices must detect ATa accurately and either prevent them from recurring or terminate them by using electrical stimulation techniques

Background: This retrospective analysis investigated whether there was a reduction in episode duration for atrial tachycardia (AT) episodes that were treated with atrial antitachycardia pacing (aATP) therapy.