Comparison And Evaluation Of Tracking Paroxysmal Atrial Fibrillation By Pacemaker And Holter

Objective:To investigate the atrial fibrillation (Af) occurred in the patients with implanted DDD(R) pacemaker by Af detecting and reviewing with the pacemaker and Holter. Beta-blocker being used on the patient’s condition and its influence on heart rate, pacing and atrial arrhythmia being evaluated by the pacemaker and Holter reviewing at regular intervals to get the evidence for Af monitoring and intervention effectively.Methods:Thirty-one patients with sick sinus syndrome or atrioventricular block and the DDD (R) pacemakers with the function to detect and review Af being implanted in our hospital in the last two years were studied. At the begging, the data in the pacemakers was initiated and at the third month and sixth month the data in the pacemaker and Holter was reviewed. Beta-blocker was used on the patient’s condition and its influence on heart rate, pacing and atrial arrhythmia was evaluated by the pacemaker and Holter reviewing at regular intervals. The main indexes were (1) The Af% detected by pacemaker and Holter; (2) The events of automatic mode switch (AMS) triggered by Af, AMS persisting time, AMS%, atrial pacing% and ventricular pacing% detected and calculated by the pacemaker at regular intervals; (3) The averaged heart rate, atrial premature beats, atrial tachycardia events and Af events detected and calculated by Holter. The multielement regression analysis on Af was done.Results:(1) Af was detected in 6 cases (19.35%) by pacemaker, which is significantly higher than that by Holter (2 cases,6.45%,P=0.032);(2) In the following up by Holter after beta-blocker being used, the average heart rate decreased significantly (73.04±6.18bpm vs 67.61±4.10bpm, p<0.01), the atrial premature decreased (1.00/24h vs 0.00/24h, p=0.013) and the total number of premature atrial decreased (119.50/24h vs 28.50/24h, p=0.032);(3) In the following up by pacemaker reviewing after beta-blocker being used the PAf-AMS% decreased (4.20%vs2.10%,P=0.043), the percentage of heart rate in low frequency band (50-70bpm) increased significantly (53.14±22.83%,64.82±17.51%, p=0.01), and that in high frequency band (70bpm and above) reduced significantly (47.57±21.55% vs 34.82±17.65%, p<0.01), atrial pacing% increased significantly (42.00±28.83% vs 49.14±31.39%,p=0.04), and ventricular pacing% unchanged significantly (46.06±36.80%vs45.93±36.86%, p=0.861). (4) Age and enlarged left atrium was related closely to Af in the patients with implanted DDD(R) pacemaker (P=0.027,P=0.006).Conclusion:(1)The current DDD(R) pacemaker with the function to detect and review atrial tachycardia could be used to detect and evaluate paroxysmal atrial fibrillation which is difficult to be found in clinical practice and by Holter. (2) Paroxysmal atrial fibrillation could be detected by the pacemaker and evaluated quantitatively by the indexes AMS events and AMS%; (3) Beta-blocker could decrease heart rate and Af occurrence and would be beneficial to optimize pacing.