Ambulatory Holter monitoring in asymptomatic patients with DDD pacemakers – do we need ACC/AHA Guidelines revision?

Abstract

IntroductionWe sought to determine the usefulness of ambulatory 24-hour Holter monitoring in detecting asymptomatic pacemaker (PM) malfunction episodes in patients with dual-chamber pacemakers whose pacing and sensing parameters were proper, as seen in routine post-implantation follow-ups.Material and methodsAmbulatory 24-hour Holter recordings (HM) were performed in 100 patients with DDD pacemakers 1 day after the implantation. Only asymptomatic patients with proper pacing and sensing parameters (assessed on PM telemetry on the first day post-implantation) were enrolled in the study. The following parameters were assessed: failure to pace, failure to sense (both oversensing and undersensing episodes) as well as the percentage of all PM disturbances.ResultsDespite proper sensing and pacing parameters, HM revealed PM disturbances in 23 patients out of 100 (23%). Atrial undersensing episodes were found in 12 patients (p < 0.005) with totally 963 episodes and failure to capture in 1 patient (1%). T wave oversensing was the most common ventricular channel disorder (1316 episodes in 9 patients, p < 0.0005). Malfunction episodes occurred sporadically, leading to pauses of up to 1.6 s or temporary bradycardia, which were, nevertheless, not accompanied by clinical symptoms. No ventricular pacing disturbances were found.ConclusionsAsymptomatic pacemaker dysfunction may be observed in nearly 25% of patients with proper DDD parameters after implantation. Thus, ambulatory HM during the early post-implantation period may be a useful tool to detect the need to reprogram PM parameters.

Inny scenariusz hamowania kardiostymulatora typu DDD. Czy zawsze winne są elektrody unipolarne?

“…In pacemaker-dependent patients, pacemaker inhibition may result in syncope, imbalance and/or dizziness recurrence. This fi nding may be recorded during Holter ECG monitoring [1]. Very similar ECG recordings can be seen with different mechanisms.…”

Accuracy of the pacemaker event recorder versus Holter‐ECG to detect both symptomatic and asymptomatic ventricular arrhythmias

“…A huge contribution was obtained with the development of implantable cardioverter defibrillators (ICDs), which use algorithms for recognizing sustained ventricular arrhythmias. More recently, the development of the remote monitoring function enabled continuous monitoring not only of the electronic and technical parameters of the devices, but also of several clinical parameters such as the rhythm, autonomic, and hemodynamic functioning of the patients, using transtelephonic data transmission methodology …”

“…Few studies were performed evaluating the quality of the pacemakers’ recordings of ventricular arrhythmias. It is of utmost importance to verify the consistency of these records in order to consolidate the usefulness of this tool for long‐term follow‐up of patients who carry implanted pacemakers …”

“…It is of utmost importance to verify the consistency of these records in order to consolidate the usefulness of this tool for long-term follow-up of patients who carry implanted pacemakers. 13…”

Holter ECG for pacemaker/defibrillator carriers: what is its role in the era of remote monitoring?

“…More recently, Chudzik and Wranicz reconsidered this approach in view of the prevalence >20% of ‘subtle’ PM malfunctions recorded at 24 h AECG the day after implant. Notably, these episodes occurred asymptomatically and in the absence of significant pauses/bradycardia 22 23. Considering that about 600 000 CIED are implanted each year worldwide, this would turn into a huge clinical/economic burden unsupported by proved clinical improvement 24.…”