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Pacemaker diagnostics in atrial fibrillation: limited usefulness for therapy initiation in a pacemaker practice
Neeraja Yedlapati1, John D Fisher
1Division of Cardiology, Department of Medicine, Arrhythmia Service, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Pacing and Clinical Electrophysiology : PACE
|April 15, 2014
Summary
Pacemaker diagnostics rarely led to new atrial fibrillation (AF) diagnoses or medication changes in general practice. Current systems offer limited therapeutic impact, suggesting a need for improved automated monitoring for AF detection.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Atrial fibrillation (AF) is a common arrhythmia.
- Pacemakers with diagnostic capabilities can detect AF.
- The clinical utility of pacemaker-detected AF in routine practice is not well-established.
Purpose of the Study:
- To evaluate the practical value of pacemaker diagnostics for AF detection.
- To assess the impact on workflow and initiation of anticoagulation or antiarrhythmic drug (AAD) therapy.
Main Methods:
- Prospective follow-up of consecutive pacemaker interrogations over one year.
- Identification of patients with AF (1-99% burden).
- Contacting referring physicians to determine therapeutic changes post-AF detection.
Main Results:
- Of 728 dual-chamber pacemakers, AF was recorded in 66 patients.
- Pacemaker-diagnosed AF led to new anticoagulation in only 4 patients (6%).
- New AADs were initiated in only 2 patients (3%).
Conclusions:
- Pacemaker diagnostics had minimal therapeutic impact on medication changes (6 patients, 0.8%).
- Cumbersome workflow and pre-existing knowledge of AF limited clinical utility.
- Automated monitoring systems may offer more accessible and therapeutically beneficial AF detection.
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