Pacemaker diagnostics in atrial fibrillation: Limited usefulness for therapy initiation in a pacemaker practice

Neeraja Yedlapati, John Devens Fisher

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Aim We aimed to determine the practical value of pacemaker diagnostics for atrial fibrillation (AF) in an unselected general pacemaker practice, specifically workflow and initiation of anticoagulation or antiarrhythmic drug (AAD) therapy. Methods We prospectively followed consecutive pacemaker interrogations over a period of 1 year to identify patients with AF (burden from 1% to 99%). We contacted referring physicians with AF details, and then determined whether the information resulted in therapeutic changes. Results Of the 1,100 pacemakers interrogated, 728 were dual chamber (DDDs) with AF diagnostic capability. AF was recorded in 73 (10%) but seven had limited information, leaving 66 patients; of these, 42 (63%) patients were already anticoagulated and in five (7%) patients, anticoagulation had been stopped because of complications. Initial diagnosis of AF was made by the pacemaker in 17 patients (26% of 66; 2% of 728); four (6% of 66) patients were newly initiated on anticoagulation. Of the 66 patients, 17 patients were already on AADs; 49 (74%) had satisfactory rate control or had other issues; only two (3% of 66; 0.3% of 728) received new AADs. Conclusions Of 728 patients with DDD pacemakers, only 17 were newly discovered to have AF, and six (0.8%) had changes in medications based on the pacemaker data. Adding pacemaker-derived data to existing clinical information had little therapeutic impact, due to a combination of cumbersome workflow, and because AF was usually known to practitioners. Developments in automated monitoring systems may provide more accessible and therapeutically useful information.

Original languageEnglish (US)
Pages (from-to)1189-1197
Number of pages9
JournalPACE - Pacing and Clinical Electrophysiology
Volume37
Issue number9
DOIs
StatePublished - Sep 1 2014

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Atrial Fibrillation
Dichlorodiphenyldichloroethane
Therapeutics
Workflow
Anti-Arrhythmia Agents
General Practice
Physicians
Drug Therapy

Keywords

  • AF burden
  • atrial fibrillation
  • pacemaker
  • pacemaker diagnostics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Pacemaker diagnostics in atrial fibrillation : Limited usefulness for therapy initiation in a pacemaker practice. / Yedlapati, Neeraja; Fisher, John Devens.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 37, No. 9, 01.09.2014, p. 1189-1197.

Research output: Contribution to journalArticle

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abstract = "Aim We aimed to determine the practical value of pacemaker diagnostics for atrial fibrillation (AF) in an unselected general pacemaker practice, specifically workflow and initiation of anticoagulation or antiarrhythmic drug (AAD) therapy. Methods We prospectively followed consecutive pacemaker interrogations over a period of 1 year to identify patients with AF (burden from 1{\%} to 99{\%}). We contacted referring physicians with AF details, and then determined whether the information resulted in therapeutic changes. Results Of the 1,100 pacemakers interrogated, 728 were dual chamber (DDDs) with AF diagnostic capability. AF was recorded in 73 (10{\%}) but seven had limited information, leaving 66 patients; of these, 42 (63{\%}) patients were already anticoagulated and in five (7{\%}) patients, anticoagulation had been stopped because of complications. Initial diagnosis of AF was made by the pacemaker in 17 patients (26{\%} of 66; 2{\%} of 728); four (6{\%} of 66) patients were newly initiated on anticoagulation. Of the 66 patients, 17 patients were already on AADs; 49 (74{\%}) had satisfactory rate control or had other issues; only two (3{\%} of 66; 0.3{\%} of 728) received new AADs. Conclusions Of 728 patients with DDD pacemakers, only 17 were newly discovered to have AF, and six (0.8{\%}) had changes in medications based on the pacemaker data. Adding pacemaker-derived data to existing clinical information had little therapeutic impact, due to a combination of cumbersome workflow, and because AF was usually known to practitioners. Developments in automated monitoring systems may provide more accessible and therapeutically useful information.",
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