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.