Effect of stored electrograms on management in the paced patient

Advances in modern pacemaker technology offer possibilities to diagnose asymptomatic arrhythmias and to document the causal relation between symptoms and infrequently occurring arrhythmias. Diagnostic and memory functions of pacemakers allow both the automatic detection of arrhythmias and retrieval of stored electrograms of the arrhythmia episodes. Asymptomatic episodes of atrial fibrillation (AF), sustained ventricular tachycardia (VT), and nonsustained VT of the patients with impaired left ventricular function may have real clinical importance in pacemaker patients. Recognition of these arrhythmias may result in changes in the treatment of the patients, such as anticoagulation of patients with episodes of paroxysmal AF, and therapy guided by electrophysiologic testing of patients with nonsustained or sustained VT. Stored electrograms may also help in defining whether the symptoms experienced by pacemaker patients are due to arrhythmias. Improvements in the arrhythmia detection algorithms and memory functions will still be needed in the future to reliably detect the occurrence of various arrhythmias in pacemaker patients. After these improvements, the diagnostic features of pacemakers should offer a unique opportunity to further improve the clinical management of pacemaker patients.