HRS: Elderly AF patients with pacemakers better managed remotely

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DENVER—There was high atrial fibrillation (AF) incidence in elderly pacemaker patients and remote monitoring is useful to detect and treat AF earlier regarding antithrombotic and anti-arrhythmic therapy, according to a poster study presented Thursday at the 31st annual Heart Rhythm Society’s scientific sessions.

Lead author Carlos E. Lima, MD, from the University of Sao Paulo in Brazil, and colleagues sought to compare standard follow-up and remote monitoring in elderly pacemaker patients through this randomized, prospective study.

Between March 2007 and September 2009, the researchers consecutively selected 267 patients (43 percent, male) with classical indication to atrioventricular pacemaker implantation. Patients in sinus rhythm were 60 years or older.

Lima said that he and his colleagues randomized (1:1) 135 patients in the remote arm and 132 patients in the control arm. The median follow-up time was 252 days. Follow-up was scheduled in one, three, six, 12, 18 and 24 months. Patients in the remote arm had extra appointments if mode switch was 10 percent or more in a day.

According to Lima, there was no difference between studied groups, remote versus control, for:
  • Age (75.2 vs. 74.1 years);
  • Gender (42.9 vs. 43.9 percent);
  • Pacemaker indication (SSS 14/10.37 percent vs. SSS 15/11.53 percent) & (CAVB 121/89.62 percent vs. CAVB 117/88.63 percent;
  • CHADS2 score of at least two: 79 (58.51 percent) versus 77 (58.33 percent);
  • AF incidence: 25 (18.51 percent) versus 25 (18.93 percent);
  • Stroke: 1.48 percent versus 0 percent.

The researchers reported that the pacemakers’ counters detected AF correctly in 89.3 percent.

Lima said that the time to first AF was detected 48 days in the remote arm and 85 days in the control arm; and AF burden was 1.4 hours per day versus 1.46 hours per day, respectively.

Finally, Lima and colleagues found that there were 52 extra appointments with a change in the current therapy in 86.5 percent of them (52 percent anti-thrombotic therapy, 22 percent anti-arrhythmic therapy, 4 percent pacemaker programming and 4 percent cardioversion.