AF burden and recording on an AF episode

Patient

This 57-year-old man received an Ensura dual chamber pacemaker for management of complete AV block; he had a history of paroxysmal AF treated with amiodarone and was seen for routine follow-up.

Trace

Tracing 7a: initial interrogation and AT/AF summary;

this summary provides general information regarding the AF burden and compares with previous interrogations; it offers details regarding the percentage of time spent in arrhythmia, the mean duration of AF and the number of daily arrhythmic episodes;

Tracing 7b: analysis of the episodes of atrial arrhythmia;

this episode lasted >2 hours with a rapid atrial rate, fallback and pacing at the resting rate;

Tracing 7c: graphic representation of the episode;

sinus rhythm with 1:1 AV association;
onset of atrial arrhythmia with AV dissociation and ventricular paced rhythm in fallback;

Tracing 7d: EGM corresponding to this episode;

atrial arrhythmia accurately detected by the pacemaker and ventricular pacing;

Comments

The interrogation of the pacemaker memory is an indispensable step of routine interrogations. It enables the detection of symptomatic or asymptomatic arrhythmic episodes, and ascertains their rate, number and evolution as a function of the various treatments attempted, and their impact on ventricular conduction.
The ability of viewing the graphs and EGMs pertaining to these episodes allows a verification of the diagnosis made by the pacemaker and the elimination of false positive diagnoses, such as those due to far-field sensing.

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