Management of atrial fibrillation--what are the possibilities of early detection with home monitoring?

Abstract

A large number of patients implanted with dual-chamber pacemakers exhibit symptoms of recurrent or new atrial fibrillation. Scheduling follow-up visits for every 6-12 months in this setting may be disadvantageous on three grounds. First, delayed information about the onset of atrial fibrillation does not allow an immediate reaction with pharmacological or dedicated pacing therapy. Second, the efficacy of the chosen therapy cannot be evaluated until the next scheduled follow-up. Third, real-time awareness of a significant atrial fibrillation burden is critical to use appropriate anticoagulation therapy for the prevention of thromboembolic events. The new Home Monitoring technology (Biotronik, Berlin) offers real-time transmission of diagnostic data stored in the pacemaker memory to the physician. This may represent a useful tool for the detection and treatment of patients with atrial fibrillation. Daily documentation of atrial rhythm via Home Monitoring allows a quick reaction to the onset of atrial fibrillation and real-time control of the therapeutic efficacy. The ongoing, international, randomized Home-PAT clinical trial aims at defining and quantifying the importance of Home Monitoring for the diagnosis and treatment of atrial fibrillation in patients with dual-chamber pacemakers.