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

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...

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Published in:Journal of cardiovascular electrophysiology 2020-10, Vol.31 (10), p.2704-2710
Main Authors: Phillips, Kari A., Ponamgi, Shiva, Mundell, Benjamin, Krushelnytskyy, Mykhaylo, Li, Zhuo, Rea, Robert, Deshmukh, Abhishek, McLeod, Christopher, Espinosa, Raul E., Osborn, Michael, Friedman, Paul A., Mulpuru, Siva K., Cha, Yong‐Mei, Neutzling, Lori B., Munger, Thomas, Kancharla, Krishna, Asirvatham, Samuel J.
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Language:English
Subjects:
Congestive heart failure
dual‐chamber pacemaker
Dyspnea
elective replacement indicator
Fibrillation
Intolerance
Pacemakers
Respiration
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cited_by cdi_FETCH-LOGICAL-c3537-253c71e29ef81c7ce468032ff39502001650b8a703b2dfd3eb158ea8ecb0395a3
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creator Phillips, Kari A.
Ponamgi, Shiva
Mundell, Benjamin
Krushelnytskyy, Mykhaylo
Li, Zhuo
Rea, Robert
Deshmukh, Abhishek
McLeod, Christopher
Espinosa, Raul E.
Osborn, Michael
Friedman, Paul A.
Mulpuru, Siva K.
Cha, Yong‐Mei
Neutzling, Lori B.
Munger, Thomas
Kancharla, Krishna
Asirvatham, Samuel J.
description 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 
doi_str_mv 10.1111/jce.14677
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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 &lt; .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.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.14677</identifier><identifier>PMID: 32671902</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Congestive heart failure ; dual‐chamber pacemaker ; Dyspnea ; elective replacement indicator ; Fibrillation ; Intolerance ; Pacemakers ; Respiration</subject><ispartof>Journal of cardiovascular electrophysiology, 2020-10, Vol.31 (10), p.2704-2710</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3537-253c71e29ef81c7ce468032ff39502001650b8a703b2dfd3eb158ea8ecb0395a3</citedby><cites>FETCH-LOGICAL-c3537-253c71e29ef81c7ce468032ff39502001650b8a703b2dfd3eb158ea8ecb0395a3</cites><orcidid>0000-0002-5897-9464 ; 0000-0003-3235-1596 ; 0000-0002-7694-3617 ; 0000-0001-5052-2948 ; 0000-0001-9835-5536 ; 0000-0002-9560-1102</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32671902$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Phillips, Kari A.</creatorcontrib><creatorcontrib>Ponamgi, Shiva</creatorcontrib><creatorcontrib>Mundell, Benjamin</creatorcontrib><creatorcontrib>Krushelnytskyy, Mykhaylo</creatorcontrib><creatorcontrib>Li, Zhuo</creatorcontrib><creatorcontrib>Rea, Robert</creatorcontrib><creatorcontrib>Deshmukh, Abhishek</creatorcontrib><creatorcontrib>McLeod, Christopher</creatorcontrib><creatorcontrib>Espinosa, Raul E.</creatorcontrib><creatorcontrib>Osborn, Michael</creatorcontrib><creatorcontrib>Friedman, Paul A.</creatorcontrib><creatorcontrib>Mulpuru, Siva K.</creatorcontrib><creatorcontrib>Cha, Yong‐Mei</creatorcontrib><creatorcontrib>Neutzling, Lori B.</creatorcontrib><creatorcontrib>Munger, Thomas</creatorcontrib><creatorcontrib>Kancharla, Krishna</creatorcontrib><creatorcontrib>Asirvatham, Samuel J.</creatorcontrib><title>Clinical implications of elective replacement indicator setting changes in patients with dual‐chamber pacemaker devices</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>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 &lt; .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.</description><subject>Congestive heart failure</subject><subject>dual‐chamber pacemaker</subject><subject>Dyspnea</subject><subject>elective replacement indicator</subject><subject>Fibrillation</subject><subject>Intolerance</subject><subject>Pacemakers</subject><subject>Respiration</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp10ctO3DAUBmCrKioUuugLVJbYwCLga-xZohFQEFI3ZR05zgl4cC61E9Ds-gg8I0_SMx3oAqne5Ejn8y9HPyFfOTvheE5XHk64Ko35QPa4VqywvDQfcWZKF9IauUs-57xijMuS6U9kV4rS8AUTe2S9jKEP3kUaujHiMIWhz3RoKUTwU3gEmmCMzkMH_URD32zMkGiGaQr9HfX3rr-DjBs64mVEmT6F6Z42s4svv59x39WQcIkR7gGnBh6Dh3xAdloXM3x5_e6T24vzn8vvxc2Py6vl2U3hpZamEFp6w0EsoLXcGw-qtEyKtpULzQT-UqlZbZ1hshZN20ioubbgLPiaIXFynxxtc8c0_JohT1UXsocYXQ_DnCuhhFLKSM2RHr6jq2FOPb4OlbLCMis26nirfBpyTtBWYwqdS-uKs2rTR4V9VH_7QPvtNXGuO2j-ybcCEJxuwVOIsP5_UnW9PN9G_gF5sJZW</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Phillips, Kari A.</creator><creator>Ponamgi, Shiva</creator><creator>Mundell, Benjamin</creator><creator>Krushelnytskyy, Mykhaylo</creator><creator>Li, Zhuo</creator><creator>Rea, Robert</creator><creator>Deshmukh, Abhishek</creator><creator>McLeod, Christopher</creator><creator>Espinosa, Raul E.</creator><creator>Osborn, Michael</creator><creator>Friedman, Paul A.</creator><creator>Mulpuru, Siva K.</creator><creator>Cha, Yong‐Mei</creator><creator>Neutzling, Lori B.</creator><creator>Munger, Thomas</creator><creator>Kancharla, Krishna</creator><creator>Asirvatham, Samuel J.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5897-9464</orcidid><orcidid>https://orcid.org/0000-0003-3235-1596</orcidid><orcidid>https://orcid.org/0000-0002-7694-3617</orcidid><orcidid>https://orcid.org/0000-0001-5052-2948</orcidid><orcidid>https://orcid.org/0000-0001-9835-5536</orcidid><orcidid>https://orcid.org/0000-0002-9560-1102</orcidid></search><sort><creationdate>202010</creationdate><title>Clinical implications of elective replacement indicator setting changes in patients with dual‐chamber pacemaker devices</title><author>Phillips, Kari A. ; Ponamgi, Shiva ; Mundell, Benjamin ; Krushelnytskyy, Mykhaylo ; Li, Zhuo ; Rea, Robert ; Deshmukh, Abhishek ; McLeod, Christopher ; Espinosa, Raul E. ; Osborn, Michael ; Friedman, Paul A. ; Mulpuru, Siva K. ; Cha, Yong‐Mei ; Neutzling, Lori B. ; Munger, Thomas ; Kancharla, Krishna ; Asirvatham, Samuel J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3537-253c71e29ef81c7ce468032ff39502001650b8a703b2dfd3eb158ea8ecb0395a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Congestive heart failure</topic><topic>dual‐chamber pacemaker</topic><topic>Dyspnea</topic><topic>elective replacement indicator</topic><topic>Fibrillation</topic><topic>Intolerance</topic><topic>Pacemakers</topic><topic>Respiration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Phillips, Kari A.</creatorcontrib><creatorcontrib>Ponamgi, Shiva</creatorcontrib><creatorcontrib>Mundell, Benjamin</creatorcontrib><creatorcontrib>Krushelnytskyy, Mykhaylo</creatorcontrib><creatorcontrib>Li, Zhuo</creatorcontrib><creatorcontrib>Rea, Robert</creatorcontrib><creatorcontrib>Deshmukh, Abhishek</creatorcontrib><creatorcontrib>McLeod, Christopher</creatorcontrib><creatorcontrib>Espinosa, Raul E.</creatorcontrib><creatorcontrib>Osborn, Michael</creatorcontrib><creatorcontrib>Friedman, Paul A.</creatorcontrib><creatorcontrib>Mulpuru, Siva K.</creatorcontrib><creatorcontrib>Cha, Yong‐Mei</creatorcontrib><creatorcontrib>Neutzling, Lori B.</creatorcontrib><creatorcontrib>Munger, Thomas</creatorcontrib><creatorcontrib>Kancharla, Krishna</creatorcontrib><creatorcontrib>Asirvatham, Samuel J.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium &amp; 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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 &lt; .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.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32671902</pmid><doi>10.1111/jce.14677</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-5897-9464</orcidid><orcidid>https://orcid.org/0000-0003-3235-1596</orcidid><orcidid>https://orcid.org/0000-0002-7694-3617</orcidid><orcidid>https://orcid.org/0000-0001-5052-2948</orcidid><orcidid>https://orcid.org/0000-0001-9835-5536</orcidid><orcidid>https://orcid.org/0000-0002-9560-1102</orcidid></addata></record>
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subjects Congestive heart failure
dual‐chamber pacemaker
Dyspnea
elective replacement indicator
Fibrillation
Intolerance
Pacemakers
Respiration
title Clinical implications of elective replacement indicator setting changes in patients with dual‐chamber pacemaker devices
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