OBJECTIVE

To optimize the management of patients with atrial fibrillation (AF) and pacemaker within a month after implantation.

MATERIAL AND METHODS

The study included 103 patients (39 men and 64 women, mean age 76.4±8.9 years) with paroxysmal AF and implanted dual-chamber pacemaker de novo. Antiarrhythmic drugs class Ic, II, and III were administered. All patients underwent ECG, 24-hour ECG monitoring and 6-minute walk test (SMWT), three months later — the first pacemaker checking and repeated SMWT. Patients were divided into 2 groups: group 1 — 20 patients with heart failure (HF) progression, group 2 — 18 patients without HF progression. Statistical analysis included Pearson’s χ² test, Fisher’s Z-test. Differences were significant at p-value <0.05.

RESULTS

Short AF paroxysms and episodes of high atrial frequency were detected in 70% of patients including 68% within a month after implantation. In 9 (8.7%) patients, arrhythmia turned into permanent tachysystolic AF. Correction of pacemaker settings was required in 41 patients, including 20 ones for AF and/or antiarrhythmic therapy. Significantly faster deterioration of HF was found in patients with hypertrophy and diastolic dysfunction of the left ventricle, right ventricle dilatation. None of patients in the 1 group had any complaints of decreased exercise tolerance before SMWT.

CONCLUSION

In patients with paroxysmal AF, pacemaker should be checked in 1 month after implantation. In patients with frequent switching of the right ventricular electrode, pacemaker control should be accompanied by SMWT. This is especially true if left ventricle hypertrophy and diastolic dysfunction and right ventricle dilatation were diagnosed during primary echocardiography.