Clinically guided pacemaker choice and setting: pacemaker expert programming study.

Matteo Ziacchi,Michele Accogli,Pietro Palmisano,Stefano Aquilani,Federico Guerra,Giampiero Maglia,Giuseppe Del Giorno,Vittorio Aspromonte,Mauro Biffi,Ernesto Ammendola,Eraldo Occhetta,Renato Pietro Ricci,Giuseppe Boriani,Alessandro Capucci,Gabriele Dell'Era

doi:10.1093/europace/euw256

Abstract

The aim of this multicentre, observational, transversal study was to evaluate pacemaker (PM) choice and setting in a large number of patients, in order to understand their relationship with the patients' clinical characteristics. The study enrolled a total of 1858 patients (71 ± 14 years, 54% male), consecutively evaluated during scheduled PM follow-up visits in 7 Italian cardiac arrhythmia centres. To evaluate the appropriateness of PM choice in relation to the patients' clinical characteristics, we analysed their rhythm disorders at the time of device implantation and the characteristics of the devices implanted. To evaluate the appropriateness of device setting, current rhythm disorders and device setting at the time of enrolment were analysed. In the overall study population, 64.3% of the patients received a PM with all of the features required for their rhythm disorder [80.8% in persistent atrioventricular (AV) block, 76.5% in atrial fibrillation needing pacing, 71.0% in sinus node disease, 58.7% in non-persistent atrioventricular block (AVB), 52.7% in neuro-mediated syncope]. The most frequent cause of inappropriate PM choice was the lack of an algorithm to promote intrinsic AV conduction in non-persistent AVB patients (38.1%). In 76.2% of the patients with an appropriate PM (n = 1301), the PM was optimally set for their rhythm disorder. In the present 'real-world' registry, a large number of patients (35.7%) did not receive an optimal PM for their rhythm disorders. Moreover, one-fourth of appropriate PMs were not programmed according to the patients' clinical characteristics.

Highlights

Pacemakers (PMs) are life-saving devices and are widely used for the treatment of bradyarrhythmias
In the last 10 years, PM technology has improved, and manufacturers have developed several algorithms that have potentially useful clinical implications. It is not currently known how technological improvements have been perceived by physicians nor whether specific disease-driven PM setting is always implemented in device programming
Two or more associated rhythm disorders were recorded in 6.8% of patients

Summary

Introduction

Pacemakers (PMs) are life-saving devices and are widely used for the treatment of bradyarrhythmias. In Italy alone, 65 554 PMs were implanted[1] in 2013 ( 900 PMs/million population), a 3% increase over the 2012 figure This number is expected to rise as the population ages.[2] In the last 10 years, PM technology has improved, and manufacturers have developed several algorithms that have potentially useful clinical implications. It is not currently known how technological improvements have been perceived by physicians nor whether specific disease-driven PM setting is always implemented in device programming.

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Conclusion