Clinical implications of elective replacement indicator setting changes in patients with dual‐chamber pacemaker devices. (24th July 2020)

• Record Type: Journal Article
• Authors: Phillips, Kari A.; Ponamgi, Shiva; Mundell, Benjamin; Krushelnytskyy, Mykhaylo; Li, Zhuo; Rea, Robert; Deshmukh, Abhishek; McLeod, Christopher; Espinosa, Raul E.; Osborn, Michael; Friedman, Paul A.; Mulpuru, Siva K.; Cha, Yong‐Mei; Neutzling, Lori B.; Munger, Thomas; Kancharla, Krishna; Asirvatham, Samuel J.
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 31:Number 10(2020)
• Page Start: 2704
• Page End: 2710
• Publication Date: 2020-07-24
• Subjects: dual‐chamber pacemaker -- elective replacement indicator; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.14677
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Objective: This study sought to determine if single‐chamber operation and/or loss of rate response (RR) during elective replacement indicator (ERI) in patients with dual‐chamber pacemakers lead to increased symptom burden, healthcare utilization, and atrial fibrillation (AF). Background: Dual‐chamber pacemakers often change from dual‐ to single‐chamber pacing mode and/or lose RR functionality at ERI to preserve battery. Single‐chamber pacing increases the incidence of heart failure, AF, and pacemaker syndrome suggesting these changes may be deleterious. Methods: A retrospective analysis of 700 patients was completed. Three comparisons were analyzed: Comparison 1: mode change and RR loss versus no change; Comparison 2: RR loss only versus no change; Comparison 3: mode change only versus no change (in patients with no RR programmed at baseline). Results: In Comparison 1, 121 (46%) patients with setting changes experienced symptoms (most often dyspnea and fatigue/exercise intolerance) versus 3 (4%) without setting changes ( p < .0001). Similar results were noted in Comparisons 2 and 3 ( p = .0016 and p = .0001, respectively). In Comparison 1, patients with setting change sought provider contact more than patients without setting changes ( p = .0001). A significant difference was not noted in Comparison 2 or 3. Overall 14 (2%) patients were hospitalized, all of whom had setting changes. Conclusions: Setting changes at ERI including a change from dual‐ to single‐chamber pacing and/or loss of RR results in a significantly increased symptom burden and increased healthcare utilization.