Incidence of atrial tachyarrhythmias in pacemaker patients: results from the Balanced Evaluation of Atrial Tachyarrhythmias in Stimulated patients (BEATS) study.
OBJECTIVE
The prospective Balanced Evaluation of Atrial Tachyarrhythmias in Stimulated patients (BEATS) study compared atrial tachyarrhythmia (AT) detection by means of serial ECG recordings versus device detection.


BACKGROUND
The annual incidence of AT in patients with dual-chamber pacemakers may be significantly underestimated based on ECG and Holter recordings.


METHODS
A DDD(R) device capable of AT-triggered dual-channel electrogram (EGM) storage was implanted in 254 patients (70 +/- 11 years, 159 men) with a class I pacing indication. Patients were seen at 6, 26, and 52 weeks after pacemaker implantation. At all visits, symptoms were checked, surface ECGs were recorded including a 24-hour Holter recording at 6 weeks, and the pacemakers were interrogated. Primary study endpoint was AT documentation by surface ECG/Holter versus stored EGMs. Secondary endpoints consisted of the association between patients' symptoms and AT documentation, and of the AT incidence depending on pacing indication and a history of AT.


RESULTS
ATs were documented by ECG/Holter recordings in 37 patients (15%) and by stored EGMs in 137 patients (54%) (P < 0.0001). Symptoms were absent in 108 of 137 patients (79%) with device-documented AT but present in 70 of 117 patients (60%) without AT documentation. AT documentation was more frequent in patients with a history of AT but not in patients with sinus node compared to AV node disease.


CONCLUSIONS
ATs occur in pacemaker patients significantly more frequently than estimated by ECG/Holter recordings. Only the analysis of device-stored EGMs allows reliable assessment of the AT burden.
Israel
Carsten W
CW
J. W. Goethe University, Department of Cardiology, Clinical Electrophysiology, Frankfurt, Germany.
Neubauer
Horst
H
Olbrich
Hans-Georg
HG
Hartung
Wolfgang
W
Treusch
Sven
S
Hohnloser
Stefan H
SH
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D013610:Tachycardia / Q000453:epidemiology* / Q000209:etiology