The feasibility of fully automated pacemaker advise in treating atrial tachyarrhythmias.
BACKGROUND
Modern pacemakers continuously store significant cardiac-related events. Interpreting these data and reprogramming the pacemaker can be time-consuming and demands expert knowledge. A software-based expert system, the therapy advisor (TA), was developed, which analyzes stored data and provides reprogramming recommendations. This study addresses whether pacemaker experts consider the messages that are automatically generated appropriate in the management of atrial tachyarrhythmias/atrial fibrillation (AT/AF).


METHODS
This observational, international, multicenter study follows 150 patients with suspected or documented atrial arrhythmias who received a dual-chamber pacemaker (model Vitatron T-70, Medtronic Inc., Minneapolis, MN, USA) incorporating the TA. The TA summarizes technical and clinical data stored in the pacemaker into key messages and may suggest programming changes. Twenty-five cardiologists examined their patients per normal practice during two follow-up visits. They reported the therapy changes they deemed necessary without initially reviewing the TA messages. Next, they rated their satisfaction with and the clinical relevance of the TA messages and recorded the final therapy changes.


RESULTS
The TA generated (mostly AT/AF-related) main observations in 49% and programming advice in 33% of the patients. The experts rated 95% of the TA messages as satisfactory and deemed therapy changes necessary in roughly half the patients. Pacemaker changes in AT/AF therapy or general settings were prompted primarily by the diagnostic information stored in the device. Medication changes were mostly led by the symptoms reported by the patient.


CONCLUSIONS
This study demonstrates that experienced cardiologists agree with 95% of the observations and programming suggestions that the TA automatically generates.
Ruiter
Jacob H
JH
Medisch Centrum Alkmaar, Alkmaar, The Netherlands. j.h.ruiter@mca.nl
Mulder
Elles
E
Schuchert
Andreas
A
Burri
Haran
H
Stühlinger
Markus C
MC
Hartikainen
Juha
J
Sermasi
Sergio
S
Vlasínová
Jitka
J
Mairesse
Georges H
GH
Bub
Eberhard
E
Lewalter
Thorsten
T
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000628:therapy*; D001282:Atrial Flutter / Q000188:drug therapy / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D005103:Expert Systems; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D013614:Tachycardia, Paroxysmal / Q000188:drug therapy / Q000628:therapy*