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 during ERI in patients with dual chamber pacemakers lead to increased symptom burden, healthcare utilization and atrial fibrillation. BACKGROUND Dual chamber pacemakers often change from dual to single chamber pacing mode and/or lose rate response (RR) functionality at elective replacement indicator (ERI) to preserve battery. Single chamber pacing increases the incidence of heart failure, atrial fibrillation, 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 vs no change; comparison 2) RR loss only vs no change; comparison 3) mode change only vs no change (in patients with no RR programmed at baseline). RESULTS In comparison one, 121 (46%) patients with setting changes experienced symptoms (most often dyspnea and fatigue/exercise intolerance) versus 3 (4%) without setting changes (p<0.0001). Similar results were noted in comparisons 2 and 3 (p=0.0016 and 0.0001 respectively). In comparison 1, patients with setting change sought provider contact more than patients without setting changes (p=0.0001). A significant difference was not noted in comparisons 2 or 3. Overall 14 (2%) patients were hospitalized, all of whom had setting changes. CONCLUSIONS Setting changes at ERI including change from dual to single chamber pacing and/or loss of rate response result in a significantly increased symptom burden and increased health care utilization. This article is protected by copyright. All rights reserved.