The usefulness of 24 hour Holter monitoring in asymptomatic pacemaker patients in early post-implantation period
2006
Background : Twenty four hour Holter monitoring (HM) in an early post-implantation
period in asymptomatic patients is considered as class IIb according to the ACC/AHA guidelines.
It seems that post-implantation assessment extended by 24 hour HM in these patients
might shorten hospitalization and increase safety of these patients. This aspect has not been
widely discussed so far. The aim of our study was to evaluate pacing and sensing disturbances
in asymptomatic patients with proper parameters of single and double chamber pacemakers.
Methods : Studied group included 236 patients implanted with Biotronik Actros S (single
chamber) (group I - 130 patients) and Biotronik Actros D or Axios D (group II - 106 patients)
pacemakers. In all the patients 24 hour HM was performed 1-6 days after implantation (mean 3.4)
in order to assess all pacing and sensing disturbances.
Results : Sensing disturbances were found in 2 patients from group I and 22 patients from
group II (the most frequent pacemaker failure was atrial undersensing followed by ventricular
oversensing-T wave stering). In 1 patient from group I atrial failure to pace was observed. In
whole group pacing/sensing disturbances were found in 23% of patients, nevertheless they did
not provoke any hemodynamic consequences.
Conclusions : In an early post-implantation period pacemaker disturbances occur in 23% of
asymptomatic patients being more frequent in patients with dual chamber pacemaker. Atrial
undersensing and ventricular oversensing are the most common disturbances, nevertheless
having no hemodynamic consequences they are not life-threatening. Detection of these episodes
in an early post-implantation period allows for early change in pacemakers’ parameters and
thus decreasing risk of rehospitalization. We confirmed the low usefulness of HM in patients
with single chamber pacemaker early after implantation.
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