Opportunistic screening for atrial fibrillation with a single lead device in geriatric patients.

OBJECTIVE: To determine the diagnostic yield of repeated screening for atrial fibrillation (AF) among geriatric patients. METHODS: A pragmatic prospective cohort study into applying opportunistic screening for AF with a handheld single lead ECG device (SLD) in a geriatric cohort. Consecutive patients of 65 years old and older visiting the geriatric outpatient clinic were eligible for inclusion. A 12 lead ECG was performed, followed by measurements with the SLD during every visit to the geriatric outpatient clinic. A frailty index was based on the accumulation of deficits model. RESULTS: 478 patients were eligible. Patients were excluded if they did not give informed consent (17 patients), had a pacemaker or implantable cardioverter defibrillator (20 patients), or had incomplete medical files (two patients). After exclusion, 439 patients participated in this study. The mean age was 78 years (range 65 to 100 years), 54% were female. AF was known in 89 patients (20%), first detected on the baseline ECG in four patients (1%) and first detected with the SLD in 20 patients (5%) during follow up visits. Sensitivity of the SLD was 90.0%, specificity 99.0%, negative predictive value 99.7%, and positive predictive value 73.5%. Most patients (82%) with AF were frail and 53% were severely frail. CONCLUSION: Repeated screening in geriatric patients has a five times higher diagnostic yield than usual care. It was easily combined with usual care. Because of the positive predictive value of 73.5%, it remains necessary to confirm AF with a 12 lead ECG or 24-h Holter monitoring.

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. CONCLUSION: This study demonstrates that experienced cardiologists agree with 95% of the observations and programming suggestions that the TA automatically generates.

Malfunction of the automatic slope adjustment of the QT sensor in patients with normal QT intervals.

DDDR pacemakers with QT driven sensor algorithms may be susceptible to inappropriate pacemaker tachycardia when implanted into patients who have a relatively extended cardiac repolarization. The inability to detect and measure the QT interval at near maximum sensor rate, results in an inappropriate adjustment of the automatic QT slope. Triggering pacemaker induced tachycardia.