ORIGINAL PAPER
The importance of frequent follow-up in the first year after pacemaker implantation upon detection of atrial tachyarrhythmia
1
Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
Submission date: 2016-05-18
Final revision date: 2016-06-23
Acceptance date: 2016-07-13
Publication date: 2016-09-22
Medical Studies 2016;32(3):184-188
KEYWORDS
TOPICS
ABSTRACT
Introduction: Newer pacemakers have data storage capabilities that permit detection of multiple episodes of atrial tachyarrhythmias (AT).
Aim of the research: To document the frequency, time to first AT detection after implantation, and risk factors for symptomatic episodes and to determine the prevalence and predictors of pacemaker-detected AT.
Material and methods: Patients (n = 62), from a single centre, with an implanted pacemaker that automatically recorded the cumulative daily AT burden were included in the analysis. The clinical history regarding AT was collected before implantation. Follow-ups were done at 3, 6, and 12 months after implantation with interrogation and symptoms reported from patients. Echocardiography was performed at baseline and at 12 months.
Results: Atrial tachyarrhythmia was detected by the pacemaker in 16 (25.81%) of 62 patients. AT/atrial fibrillation (AF) burden was detected after 3 months in 13 out of 16 (81.25%) patients, and in 38.46% of them there was no clinical history of AF. Asymptomatic episodes occurred in 7 patients (43.75% – 3 men and 4 women), and 2 (28.57%) of them did not have a clinical history of AF. History of AF prior to implantation was significant for the appearance of AT/AF burden (p = 0.006), and use of β-blockers significantly limited AT/AF burden (p = 0.040). Other analysed data was statistically non-significant.
Conclusions: Pacemaker-detection of AT is often the first paroxysmal AT diagnosis in asymptomatic patients. This suggests that AT data, collected from capable pacemakers and frequently reviewed, can lead to new diagnosis and early treatment in that group of patients, which could influence mortality and morbidity.
Aim of the research: To document the frequency, time to first AT detection after implantation, and risk factors for symptomatic episodes and to determine the prevalence and predictors of pacemaker-detected AT.
Material and methods: Patients (n = 62), from a single centre, with an implanted pacemaker that automatically recorded the cumulative daily AT burden were included in the analysis. The clinical history regarding AT was collected before implantation. Follow-ups were done at 3, 6, and 12 months after implantation with interrogation and symptoms reported from patients. Echocardiography was performed at baseline and at 12 months.
Results: Atrial tachyarrhythmia was detected by the pacemaker in 16 (25.81%) of 62 patients. AT/atrial fibrillation (AF) burden was detected after 3 months in 13 out of 16 (81.25%) patients, and in 38.46% of them there was no clinical history of AF. Asymptomatic episodes occurred in 7 patients (43.75% – 3 men and 4 women), and 2 (28.57%) of them did not have a clinical history of AF. History of AF prior to implantation was significant for the appearance of AT/AF burden (p = 0.006), and use of β-blockers significantly limited AT/AF burden (p = 0.040). Other analysed data was statistically non-significant.
Conclusions: Pacemaker-detection of AT is often the first paroxysmal AT diagnosis in asymptomatic patients. This suggests that AT data, collected from capable pacemakers and frequently reviewed, can lead to new diagnosis and early treatment in that group of patients, which could influence mortality and morbidity.
REFERENCES (18)
1.
Glotzer TV, Hellkamp AS, Zimmerman J, Sweeney MO, Yee R, Marinchak R, Cook J, Paraschos A, Love J, Radoslovich G, Lee KL, Lamas GA; MOST Investigators. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the atrial diagnostics ancillary study of the mode selection trial (MOST). Circulation 2003; 107: 1614-9.
2.
Healey JS, Martin JL, Duncan A, Connolly SJ, Ha AH, Morillo CA, Nair GM, Eikelboom J, Divakaramenon S, Dokainish H. Pacemaker-detected atrial fibrillation in patients with pacemakers: prevalence, predictors and current use of oral anticoagulation. Can J Cardiol 2013; 29: 224-8.
3.
Healey JS, Conolly SJ, Gold MR, Israel CW, Van Gelder IC, Capucci A, Lau CP, Fain E, Yang S, Bailleul C, Morillo CA, Carlson M, Themeles E, Kaufman ES, Hohnloser SH; ASSERT Investigators. Subclinical Atrial Fibrillation and the Risk of Stroke. N Engl J Med 2012; 366: 120-9.
4.
Glotzer TV, Daoud EG, Wyse DG, Singer DE, Ezekowitz MD, Hilker C, Miller C, Qi D, Ziegler PD. The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk: the TRENDS study. Circ Arrhythm Electrophysiol 2009; 2: 474-80.
6.
U.S Department of Health and Human Services. 1984 Health Care Financing Administration. Available at: http://www.cms.hhs.gov/.
7.
Epstein AE, DiMarco JP, Ellenbogen KA, Estes M, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 51: 2085-105.
8.
Pollak WM, Simmons JD, Interian A Jr, Atapattu SA, Castellanos A, Myerburg RJ, Mitrani RD. Clinical utility of intraatrial pacemaker stored electrograms to diagnose atrial fibrillation and flutter. Pacing Clin Electrophysiol 2001; 24: 424-9.
9.
Boriani G, Glotzer TV, Santini M, West TM, De Melis M, Sepsi M, Gasparini M, Lewalter T, Camm JA, Singer DE. Device-detected atrial fibrillation and risk for stroke: an analysis of >10 000 patients from the SOS AF project (Stroke prevention strategies based on atrial fibrillation information from implanted devices). Eur Heart J 2014; 35: 508-16.
10.
Ziegler PD, Glotzer TV, Daoud EG, Singer DE, Ezekowitz MD, Hoyt RH, Koehler JL, Coles J Jr, Wyse DG. Detection of previously undiagnosed atrial fibrillation in patients with stroke risk factors and usefulness of continuous monitoring in primary stroke prevention. Am J Cardiol 2012; 110: 1309-14.
11.
Yedlapati N, Fisher JD. Pacemaker diagnostics in atrial fibrillation: limited usefulness for therapy initiation in a pacemaker practice. Pacing Clin Electrophysiol 2014; 37: 1189-97.
12.
Nagarakanti R, Saksena S, Hettrick D, Koehler JL, Grammatico A, Padeletti L. Progression of new onset to established persistent atrial fibrillation: an implantable device-based analysis with implications for clinical classification of persistent atrial fibrillation. J Interv Card Electrophysiol 2011; 32: 7-15.
13.
Gillis AM, Morck M. Atrial fibrillation after DDDR pacemaker implantation. J Cardiovasc Electrophysiol 2002; 13: 542-7.
14.
Strickberger SA, Ip J, Saksena S, Curry K, Bahnson TD, Ziegler PD. Relationship between atrial tachyarrhytmias and symptoms. Heart Rhythm 2005; 2: 125-31.
15.
Healey JS, Connolly SJ, Gold MR, Israel CW, Van Gelder IC, Capucci A, Lau CP, Fain E, Yang S, Bailleul C, Morillo CA, Carlson M, Themeles E, Kaufman ES, Hohnloser SH; ASSERT Investigators. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 2012; 366: 120-9.
16.
Lamas G. How much atrial fibrillation is too much atrial fibrillation? N Engl J Med 2012; 366: 178-80.
17.
Boriani G, Botto GL, Padeletti L, Santini M, Capucci A, Gulizia M, Ricci R, Biffi M, De Santo T, Corbucci G, Lip GY; Italian AT-500 Registry Investigators. Improving stroke risk stratification using the CHADS2 and CHA2DS2-VASc risk scores in patients with paroxysmal atrial fibrillation by continuous arrhythmia burden monitoring. Stroke 2011; 42: 1768-70.
18.
Benezet-Mazuecos J, Rubio E, Farre J. Atrial high rate episodes in patients with dual-chamber cardiac implantable electronic devices: unmasking silent atrial fibrillation. Pace 2014; 37: 1080-6.
| eISSN: | 2300-6722 |
| ISSN: | 1899-1874 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
