[Incidence of atrial arrhythmia in patients with long term dual-chamber pacemakers. Contribution of the Holter function of pacemakers]

Abstract

The extension of the RAM memories in the latest generation of pacemakers has enabled development of Holter function allowing continuous surveillance of the cardiac rhythm. Between October 1991 and February 1995, 213 patients implanted with a Chorus 6234 or 7034 (Ela Medical) pacemaker, functioning in the DDD (R) mode, were followed up using the implanted continuous Holter function. Of the patients with no documented supraventricular arrhythmia (SVA) before implantation (n = 154), 67 (43.5%) developed SVA during an average period of one year. Male patients (p = 0.01; OR = 7.5 on multivariate analysis), high degrees of AVB (p = 0.03) and the presence of isolated or bursts of atrial extrasystoles (p = 0.004) were independent risk factors for SVA. The average time to detection of SVA was 207 days. In patients with documented SVA before implantation (n = 59), 22 (37.3%) had no recurrence during follow-up; in the other 37 cases, the average period before recurrence was 127 days. Multivariate analysis did not reveal any independent risk factor for recurrence of the arrhythmias. On the other hand, persistent but delayed atrioventricular conduction (1 degree AVB, long H-V interval or bifascicular block), seemed to protect against SVA, independently of other variables and of antiarrhythmic therapy (p = 0.008). These results suggest a high prevalence of SVA in patients on long-term pacemaker therapy, most episodes being asymptomatic. The implanted Holter function would therefore seem to be an essential tool for investigating and following up the natural history of arrhythmias in these patients.