Pacemaker diagnostics in atrial fibrillation: limited usefulness for therapy initiation in a pacemaker practice.
OBJECTIVE
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.
Division of Cardiology, Department of Medicine, Arrhythmia Service, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Neeraja
N
Yedlapati
John D
JD
Fisher
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011446:Prospective Studies
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants
AF burden; atrial fibrillation; pacemaker; pacemaker diagnostics