Atrial fibrillation, pacemaker non-dependent patient and follow-up by remote monitoring
Tracing
Manufacturer Biotronik
Device CRT
Field Management of atrial arrhythmias
N° 6
Patient
This 75-year-old man presenting with a dilated cardiomyopathy, 30% LVEF and left bundle branch block, received a Lumax 340 HF-T triple chamber defibrillator for primary prevention. He was followed remotely and, a few months after device implantation, an alert was transmitted.
Graph and trace
Yellow alert message for classified episode of atrial monitoring. The report reveals that the patient suffered several episodes of atrial fibrillation with mode switch. The ventricular rate increased in this patient with preserved AV conduction. The percentage of BiV stimulation decreased abruptly. The EGM channel showed an episode classified as SVT, with atrial fibrillation and rapid ventricular response visible on the atrial channel.
Other articles that may be of interest to you
EGM recordings
Atrial fibrillation is the most common arrhythmia recorded in recipients of implantable defibrillators, and is associated with an increased morbidity and mortality. An optimization of the management of patients presenting with episodes of atrial fibrillation is one of the main objectives of follow-ups by remote monitoring. Atrial fibrillation is associated with 2 main complications: 1) an unstable hemodynamic status, and 2) an increased incidence of thromboembolisms. Remote monitoring enables an early confirmation of the diagnosis of atrial fibrillation, particularly when the episodes are asymptomatic, as well as exclude other diagnoses, such as crosstalk or oversensing of noise originating from the atrial lead. This allows an adaptation of the antiarrhythmic drug therapy and the rapid initiation of anticoagulation.
The remote report revealed the atrial fibrillation burden, the number of episodes and mode switches, and displays histograms, curves of atrial and ventricular rates, and percentages of BiV stimulation. This patient complained of minimal symptoms attributable to the atrial arrhythmic episodes despite a rapid ventricular rate. Subclinical atrial arrhythmic episodes increase the risk of cerebral vascular accidents and systemic embolization. Remote monitoring allowed an early diagnosis and rapid introduction of anticoagulation and antiarrhythmic therapy, which would have been initiated weeks or months later with a conventional face-to-face follow-up.