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Atrial fibrillation in the pacemaker clinic
Catherine S McLellan1, Hoshiar Abdollah, F James Brennan
1Queen's University, Kingston, Ontario.
The Canadian Journal of Cardiology
|April 30, 2003
Summary
Routine electrocardiograms (ECGs) often miss underlying atrial fibrillation (AF) in patients with ventricular pacing. Pacemaker clinics can improve AF diagnosis and warfarin use, especially when AF develops post-implantation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Distinguishing underlying atrial rhythms in patients with ventricular pacing using electrocardiograms (ECGs) is challenging.
- Atrial fibrillation (AF) is frequently misidentified or unreported in this patient group.
Purpose of the Study:
- To compare atrial rhythm diagnoses between pacemaker clinics and 12-lead ECG interpretations in patients with 100% ventricular pacing.
- To investigate the relationship between long-term anticoagulation therapy and the timing of AF diagnosis relative to pacemaker implantation.
Main Methods:
- Fifty-six patients with 100% ventricular pacing were enrolled.
- Underlying atrial rhythm was determined via pacemaker programming.
- 12-lead ECGs were interpreted by cardiologists blinded to pacemaker assessment results.
Main Results:
- Of 40 patients with atrial flutter (AFL) or AF, only 28 were correctly identified by ECG.
- 16 patients (40%) with AF/AFL were not on warfarin.
- Warfarin use was significantly higher in patients diagnosed with AF/AFL before pacemaker implantation (22/25) versus after (2/15).
Conclusions:
- Routine ECGs frequently fail to recognize underlying rhythms in paced patients, particularly AF/AFL.
- This underdiagnosis may contribute to suboptimal warfarin use, especially for new-onset AF after pacing.
- Pacemaker clinics are crucial for identifying these patients and ensuring appropriate anticoagulation.