Incidence of Atrial Tachyarrhythmias in Pacemaker Patients: Results from the Balanced Evaluation of Atrial Tachyarrhythmias in Stimulated Patients (BEATS) Study

• Published in: Pacing and clinical electrophysiology 2006-06, Vol.29 (6), p.582-588
• Main Authors: ISRAEL, CARSTEN W., NEUBAUER, HORST, OLBRICH, HANS-GEORG, HARTUNG, WOLFGANG, TREUSCH, SVEN, HOHNLOSER, STEFAN H.
• Format: Article
• Language: English
• Subjects: Aged; atrial fibrillation; atrial tachyarrhythmias; Female; Follow-Up Studies; Heart Atria; Humans; Incidence; Male; memory functions; pacemaker; Pacemaker, Artificial - adverse effects; Prospective Studies; stored electrograms; Tachycardia - epidemiology; Tachycardia - etiology
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.2006.00405.x

Objectives: The prospective Balanced Evaluation of Atrial Tachyarrhythmias in Stimulated patients (BEATS) study compared atrial tachyarrhythmia (AT) detection by means of serial ECG recordings versus device detection. Background: The annual incidence of AT in patients with dual‐chamber pacemakers may be significantly underestimated based on ECG and Holter recordings. Methods: A DDD(R) device capable of AT‐triggered dual‐channel electrogram (EGM) storage was implanted in 254 patients (70 ± 11 years, 159 men) with a class I pacing indication. Patients were seen at 6, 26, and 52 weeks after pacemaker implantation. At all visits, symptoms were checked, surface ECGs were recorded including a 24‐hour Holter recording at 6 weeks, and the pacemakers were interrogated. Primary study endpoint was AT documentation by surface ECG/Holter versus stored EGMs. Secondary endpoints consisted of the association between patients' symptoms and AT documentation, and of the AT incidence depending on pacing indication and a history of AT. Results: ATs were documented by ECG/Holter recordings in 37 patients (15%) and by stored EGMs in 137 patients (54%) (P < 0.0001). Symptoms were absent in 108 of 137 patients (79%) with device‐documented AT but present in 70 of 117 patients (60%) without AT documentation. AT documentation was more frequent in patients with a history of AT but not in patients with sinus node compared to AV node disease. Conclusion: ATs occur in pacemaker patients significantly more frequently than estimated by ECG/Holter recordings. Only the analysis of device‐stored EGMs allows reliable assessment of the AT burden.