Diagnosis of atrial fibrillation by remote monitoring on the new platforms

N° 29
Manufacturer Biotronik Device PM Field Management of atrial arrhythmias

76-year-old man, implanted with an Eluna Evia DR pacemaker for paroxysmal atrioventricular block; programming in DDD mode; asymptomatic; telemedicine yellow alert message for occurrence of an atrial arrhythmia.

Graph and trace
  1. yellow alert in the setting an atrial load above the set limit and of a classified long atrial episode;
  2. in the new platforms, a telecardiology alert for atrial fibrillation is accompanied by the transmission of an EGM recorded during the episode;
  3. this EGM confirms the diagnosis of atrial arrhythmia with permanent ventricular pacing.

In this patient with impaired atrioventricular conduction, the atrial arrhythmia episodes were asymptomatic, with the ventricular rate remaining normal. The presence of subclinical atrial arrhythmia episodes increases the risk of stroke and systemic embolism. Telemedicine enabled an early diagnosis and the rapid introduction of anticoagulant and antiarrhythmic therapy, whereas in a classical face-to-face follow-up, this would only have been initiated weeks or even months later.
This example illustrates the need to confirm the accuracy of the diagnoses made by the pacemaker. A false diagnosis of AF may lead to an unnecessary introduction of anticoagulant therapy. The systematic sending of an EGM during the atrial arrhythmia episode on the newer platforms is thus an invaluable advance in the remote management of pacemaker-implanted patients.

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