PO-03-056 QUANTIFYING THE FREQUENCY AND ACCURACY OF DEVICE-INDICATED ATRIAL FIBRILLATION EPISODES ACROSS DEVICE MANUFACTURERS

Abstract

Despite standardization efforts, cardiac implantable electronic devices (CIED) report atrial fibrillation (AF) episodes differently across device manufacturers. Similarly, traditional cardiac rhythm management (CRM) protocols have failed to standardize physician-indicated AF. Thus, few studies have characterized the frequency and accuracy of device-indicated AF. This study quantified and compared physician- (‘true’ AF incidence) and device-indicated AF across two patient segments and by CIED manufacturer. Baptist Health Network in Kentucky uses a CRM care platform (Murj, Santa Cruz, CA) to manage 12,000 patients across 14 clinics. Both device- and physician- indicated AF transmissions in 10,986 CIED patients (age 76+12 yrs) including pacemakers, ICD, CRT-P, CRT-D implants between 10/1/2020-5/31/2022 were assessed. AF transmissions were also analyzed in 3,290 (30% of 10,986 pts) pacer dependent or heart block (HB) patients (defined as AV block or had a non-CRT device with average RV pacing >90%) (age 80+11 yrs). True physician-indicated AF episodes represented 31% & 33% of all pts & HB transmissions corresponding with 72% & 68% all pacing/HB pts. Device-indicated AF represented 32% & 33% all pacing/HB transmissions. Overall, 19% & 20% all pacing/HB transmissions were true positives (TP=device- & physician-indicated AF). Device percentages by manufacturer were 35% Boston Scientific, 29% St. Jude, 27% Medtronic, and 8% Biotronik. Medtronic had the lowest device-indicated AF transmissions/pt, the highest true positive rate at 75% (TPR=true positives / total device-indicated AF transmissions) & highest false negative rate at 30% (FNR=false negatives/ total device-indicated normal transmissions). Biotronik had the highest false positive rate at 50% (FPR= false positives/ total device-indicated AF transmissions) & lowest false negative rate (FNR) at 14%. The mean TPR was 61%+11% per manufacturer. The Murj CRM system allows greater standardization of device- and physician-indicated AF episodes, enabling quantification of device-indication frequency and accuracy. In this study, physician-indicated AF was common (72% all pacing patients; 68% HB patients) with often inaccurate AF device classifications. Alternating high FPR and FNR by manufacturers highlight the optimization challenge of reducing false alarms while maintaining a high TPR. Studies like this provide critical context for clinicians interpreting device-indicated events across manufacturers required by CRM.