Management of Atrial Tachyarrhythmias: Benefits of Pacemaker Diagnostics

Abstract

The aim of this prospective multicenter study was to assess the clinical benefits of the Selection (Vitatron) pacemaker diagnostic functions (AF 1.0) in the management of AF. Forty patients (71 +/- 9 years of age), with documented AF and conventional pacing indications, received a Selection. The AF 1.0 function of the pacemaker was programmed to document the AF burden, onset, daily distribution, duration, premature atrial beats before onset, and mode of onset of the last 12 episodes for AF episodes exceeding 180 beats/min. By comparing patients' symptoms records, patient conventional assessment at follow-up and AF 1.0 data, the investigators evaluated the usefulness of AF 1.0 in AF management at 3- and 6-month follow-ups. Usefulness was defined as a change in arrhythmia management prompted by the disclosure of AF 1.0 data. AF recurrences were recorded in 71% of the follow-ups with symptoms reported by patients in only 16%. Thirty-nine percent of therapeutic changes based on conventional assessment were confirmed by AF 1.0 data, and in 61% of instances, the initial changes were modified by AF 1.0 data. Changes included pacing parameters in 56% of cases, AF prevention with pacing algorithms in 37%, and medical treatment in 7%. All investigators indicated that AF 1.0 was useful in all patients. The AF 1.0 diagnostic functions offered a unique documentation of AF in asymptomatic patients, and allowed therapeutic adjustments impossible otherwise.

A controlled study on the effect of verapamil on atrial tachycaarrhythmias in patients with brady-tachy syndrome implanted with a DDDR pacemaker

“…In particular, the limited sample size does not allow to evaluate the effects of verapamil on patients' subgroups, stratified on the basis of atrial tachyarrhythmia burden. Moreover, in order to obtain a more precise assessment of verapamil's effects, specific algorithms for atrial overdrive, which per se may reduce the atrial tachyarrhythmia burden [1,2,23,24], were not programmed in the active mode in the present study.…”

Pacemaker Diagnostics to Determine Treatment and Outcome in Sick Sinus Syndrome with Paroxysmal Atrial Fibrillation

“…Pacemaker diagnostics had an impact in 55% of cases 8 . Our cohort of patients has now been followed for a mean of 18 months after pacing.…”

The Effect of Bipole Tip-to-Ring Distance in Atrial Electrodes upon Atrial Tachyarrhythmia Sensing Capability in Modern Dual-Chamber Pacemakers

“…50% of paced patients because of access to information not available from conventional clinical assessments. 34,35 The TRENDS study will recruit 3,100 patients receiving an implantable device to examine the relationship between AF/AT burden and stroke risk in nonanticoagulated subjects with stroke risk. 36 The fact that devices are now being used as an additional tool to assess patients for anti-coagulation further underlines the requirement for accurate arrhythmia detection.…”