The impact of stored atrial rhythm diagnostics in permanent pacemakers and the management of atrial fibrillation: the Vitatron Selection AFm Registry study.

INTRODUCTION: The Selection AFm Registry investigated the impact of pacemaker diagnostic data on the clinical management of patients with atrial arrhythmias, specifically atrial fibrillation (AF) through the use of advanced atrial arrhythmia monitoring features. Very few data on the clinical impact of such data has been reported in a real world setting. METHODS: Patients with known or suspected AF with a Class I or Class II indication for a dual-chamber pacemaker received the Selection AFm pacemaker. These patients were prospectively followed at pacemaker follow-up visits, and data were collected on medications and device programming. Physicians identified which therapy changes were based upon the stored data within the pacemaker. RESULTS: Two hundred eighty-two patients were enrolled. A total of 119 patients had 311 changes made to either their medications or device programming after review of diagnostic pacemaker data. Changes involved rate and rhythm control, warfarin anticoagulation, and pacemaker programmed settings. Significantly, more changes were made in patients with documented atrial arrhythmias at follow-up. CONCLUSIONS: The atrial arrhythmia recording features were used by clinicians to guide therapy-related decisions in patients with paroxysmal AF. Such data represent an additional source of clinical information for AF disease management.

Evaluating ventricular function with B-type natriuretic peptide in obstetric patients.

OBJECTIVE: To determine if a rapid serum assay for B-type natriuretic peptide (BNP) provides information regarding ventricular function in obstetric patients with acute dyspnea. STUDY DESIGN: A review of 17 charts for 15 patients was undertaken. Seven patients had preeclampsia, 3 had preterm labor treated with aggressive tocolysis, and 5 had underlying cardiac and/or pulmonary disease. Each presented with signs and symptoms consistent with acute dyspnea. Serum BNP levels were obtained and other standard diagnostic procedures performed. Each patient was treated based on the findings of the standard diagnostic procedures. RESULTS: For the 7 patients with preeclampsia, elevated serum BNP levels correlated with acute ventricular overload that responded to volume management and diuresis. Two patients had marked elevation of serum BNP levels and were found to have significant left ventricular dysfunction that was not apparent by standard clinical evaluation. For preterm labor patients on tocolysis and patients with underlying cardiac or pulmonary disease, serum BNP levels were elevated for 5 of 6 patients with evidence of acute volume overload. CONCLUSION: Serum BNP levels provided useful information for the clinical evaluation and management of obstetric patients with acute dyspnea. In 2 patients, more serious cardiac dysfunction was detected with BNP than with clinical evaluation alone.