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. 2020 Oct;31(10):2704-2710.
doi: 10.1111/jce.14677. Epub 2020 Jul 24.

Clinical implications of elective replacement indicator setting changes in patients with dual-chamber pacemaker devices

Kari A Phillips  1 , Shiva Ponamgi  2   3 , Benjamin Mundell  4 , Mykhaylo Krushelnytskyy  5 , Zhuo Li  6 , Robert Rea  7 , Abhishek Deshmukh  7 , Christopher McLeod  7 , Raul E Espinosa  7 , Michael Osborn  7 , Paul A Friedman  7 , Siva K Mulpuru  8 , Yong-Mei Cha  7 , Lori B Neutzling  9 , Thomas Munger  7 , Krishna Kancharla  3   7 , Samuel J Asirvatham  7
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Clinical implications of elective replacement indicator setting changes in patients with dual-chamber pacemaker devices

Kari A Phillips et al. J Cardiovasc Electrophysiol. 2020 Oct.

Abstract

Objective: This study sought to determine if single-chamber operation and/or loss of rate response (RR) during elective replacement indicator (ERI) in patients with dual-chamber pacemakers lead to increased symptom burden, healthcare utilization, and atrial fibrillation (AF).

Background: Dual-chamber pacemakers often change from dual- to single-chamber pacing mode and/or lose RR functionality at ERI to preserve battery. Single-chamber pacing increases the incidence of heart failure, AF, and pacemaker syndrome suggesting these changes may be deleterious.

Methods: A retrospective analysis of 700 patients was completed. Three comparisons were analyzed: Comparison 1: mode change and RR loss versus no change; Comparison 2: RR loss only versus no change; Comparison 3: mode change only versus no change (in patients with no RR programmed at baseline).

Results: In Comparison 1, 121 (46%) patients with setting changes experienced symptoms (most often dyspnea and fatigue/exercise intolerance) versus 3 (4%) without setting changes (p < .0001). Similar results were noted in Comparisons 2 and 3 (p = .0016 and p = .0001, respectively). In Comparison 1, patients with setting change sought provider contact more than patients without setting changes (p = .0001). A significant difference was not noted in Comparison 2 or 3. Overall 14 (2%) patients were hospitalized, all of whom had setting changes.

Conclusions: Setting changes at ERI including a change from dual- to single-chamber pacing and/or loss of RR results in a significantly increased symptom burden and increased healthcare utilization.

Keywords: dual-chamber pacemaker; elective replacement indicator.

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References

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