This 67-year-old man received a Lumax 540 HF-T triple chamber defibrillator for primary prevention, in the context of dilated cardiomyopathy with a 25% left ventricular ejection fraction and complete atrioventricular block. He was monitored by telecardiology and, within a few months after device implantation, an alert message was delivered.
Telemedicine report
Alert message (yellow status) for a classified episode of atrial monitoring.
This report shows that the patient developed several episodes of atrial fibrillation (increase in the arrhythmia burden in the first 24 hours) with mode switch. The ventricular rate remained controlled in this patient in complete atrioventricular block. The percentage of biventricular stimulation, therefore, remained near 100%. The episode lasted over 2 ½ hour. The EGM shows one atrial extrasystole, followed by the onset of the arrhythmia and the time of occurrence of the switch to DDI mode. The patient remained in biventricular stimulation. The EGM also shows the return of sinus rhythm.
Atrial fibrillation is the most common arrhythmia among recipients of implantable defibrillators, and is associated with an increase in morbidity and mortality. Optimizing the management of patients who develop episodes of atrial fibrillation is one of the main contributions of monitoring with telecardiology. Atrial fibrillation is associated with two main risks: 1) a poor hemodynamic tolerance, and 2) an increase in thromboembolic events. Telemedicine enables an early diagnosis of the arrhythmia, particularly when the episodes are asymptomatic, allows confirmation of the diagnosis and elimination of other, such as crosstalk or noise oversensing by the atrial lead, and enables an adaptation of the medical antiarrhythmic treatment and rapid initiation of anticoagulation.
The telemedicine report shows the atrial fibrillation burden and the number of mode switch episodes, and provides histograms, atrial and ventricular rate graphs, and percentage of stimulation. The recording of EGM begins a few seconds before the episode and ends after its termination, revealing the trigger (atrial extrasystole), confirming the accurate diagnosis made by the device and the return to sinus rhythm. In this patient in complete atrioventricular block, the episodes of atrial arrhythmia were asymptomatic, as the ventricular rate remained normal. The occurrence of subclinical episodes of atrial arrhythmia increases the risk of cerebrovascular accident and systemic embolisms. In this patient, telemedicine enabled an early diagnosis and the expedited introduction of an anticoagulant and antiarrhythmic treatment, whereas with a standard face-to-face follow-up, this treatment would have been initiated only weeks or months later.