Clinical implications of elective replacement indicator setting changes in patients with dual-chamber pacemaker...

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Device Technology

Background:

• Dual-chamber pacemakers may revert to single-chamber pacing or lose rate response (RR) at elective replacement indicator (ERI) to conserve battery.
• These modifications can potentially lead to adverse outcomes such as heart failure, atrial fibrillation (AF), and pacemaker syndrome.

Purpose of the Study:

• To investigate whether single-chamber pacing or loss of RR during ERI in dual-chamber pacemaker patients increases symptom burden, healthcare utilization, and atrial fibrillation (AF).

Main Methods:

• A retrospective analysis of 700 patients with dual-chamber pacemakers was conducted.
• Three comparisons were performed: mode change with RR loss vs. no change; RR loss only vs. no change; and mode change only vs. no change.

Main Results:

• Patients experiencing setting changes (mode change and/or RR loss) at ERI reported significantly more symptoms (dyspnea, fatigue) compared to those without changes (46% vs. 4%, p < .0001).
• Patients with setting changes also had increased provider contact (p = .0001), and all hospitalizations (2%) occurred in patients with setting changes.
• While mode change and RR loss together significantly increased symptoms and healthcare use, isolated RR loss or mode change showed less pronounced effects in some comparisons.

Conclusions:

• Elective replacement indicator (ERI) setting adjustments, including transitions to single-chamber pacing and/or loss of rate response (RR), are associated with a significant rise in patient-reported symptoms.
• These pacemaker parameter modifications also correlate with increased healthcare utilization, highlighting potential patient management challenges.