The influence of symptoms and device detected atrial tachyarrhythmias on medical management: insights from A-HIRATE.

Background: The influence of symptoms and device-detected atrial tachyarrhythmias (AT) on the management of AT in a pacemaker population has not been well described. We report the influence of symptoms and device detected AT on pharmacological disease management.
Methods: Group 1 (n = 331) included patients without and Group 2 (n = 96) included patients with prior history of AT with an approved pacemaker indication. Dual chamber pacemakers, (kappa 700 or kappa 900, Medtronic, Minneapolis, MN, USA) were implanted. The impact of symptoms, AT burden, a history of AT, and time since implant on changes in the use of anticoagulation, beta-blockers, and antiarrhythmic drugs was analyzed.
Results: A total of 232 patients experienced at least one atrial high rate episode (AHRE). AT burden was higher in Group 2. Symptoms were reported by 154 patients in Group 1 and 47 patients in Group 2. Among patients experiencing AHRE, symptoms were reported in 17 patients in Group 1 (5.3%) and 22 patients in Group 2 (24.7%). Changes in antiarrhythmic drugs and anticoagulation were influenced by history of AT and AT burden, while changes in the use of beta-blockers were influenced by symptoms. The probability of a pharmacologic therapy change decreased with time since implant for all agents except coumadin.
Conclusion: Pharmacologic AT therapy is differentially influenced by patient-reported symptoms of AT compared to device-detected asymptomatic AT. Anticoagulation and antiarrhythmic therapies are influenced by device detection of asymptomatic AT, whereas initiation of beta-blockers is more strongly influenced by symptoms.