Pacemakers: self-adjusting to the heart ?

Pacemakers: don't you appreciate innovative technology and the new ideas as they emerge from the research labs ?

SELF ADJUSTING PACEMAKER CONCEPT

The Feasibility of Fully Automated Pacemaker Advise in Treating Atrial Tachyarrhythmias
JACOB H. RUITER, M.D.*, ELLES MULDER, Ph.D.†, ANDREAS SCHUCHERT, M.D.‡, HARAN BURRI, M.D.§, MARKUS C. STÜHLINGER, M.D.¶, JUHA HARTIKAINEN, M.D.**, SERGIO SERMASI, M.D.††, JITKA VLAŠÍNOVÁ, M.D.‡‡, GEORGES H. MAIRESSE, M.D.§§, EBERHARD BUB, M.D.¶¶, and THORSTEN LEWALTER, M.D.***, on behalf of the T-STAR Study Group.
From the *Medisch Centrum Alkmaar, Alkmaar, The Netherlands ; †Medtronic, PJ Heerlen, The Netherlands ; ‡Friedrich-Ebert-Krankenhaus, Neumünster, Germany ; §University Hospital Geneva, Geneva, Switzerland ; ¶University Clinic of Innsbruck, Innsbruck, Austria ; **Kuopio University Hospital, Kuopio, Finland ; ††University Hospital Rimini, Rimini, Italy ; ‡‡University Hospital Brno, Brno, Czech Republic ; §§Cliniques du Sud-Luxembourg, Arlon, Belgium ; ¶¶Cardiologic Clinic Bub and Habbel, Holzminden, Germany ; and ***University Clinic Bonn, Bonn, Germany
Correspondence to Address for reprints: Jacob H. Ruiter, M.D., Department of cardiology, Medisch Centrum Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands. Fax: 072-5482157; e-mail: j.h.ruiter@mca.nl
Disclosures: Dr. Mulder is an employee of Medtronic. The other authors report no conflict of interest.
ABSTRACT
Background: Modern pacemakers continuously store significant cardiac-related events. Interpreting these data and reprogramming the pacemaker can be time-consuming and demands expert knowledge. A software-based expert system, the therapy advisor (TA), was developed, which analyzes stored data and provides reprogramming recommendations. This study addresses whether pacemaker experts consider the messages that are automatically generated appropriate in the management of atrial tachyarrhythmias/
atrial fibrillation (AT/AF).

Methods: This observational, international, multicenter study follows 150 patients with suspected or documented atrial arrhythmias who received a dual-chamber pacemaker (model Vitatron T-70, Medtronic Inc., Minneapolis, MN, USA) incorporating the TA . The TA summarizes technical and clinical data stored in the pacemaker into key messages and may suggest programming changes. Twenty-five cardiologists examined their patients per normal practice during two follow-up visits. They reported the therapy changes they deemed necessary without initially reviewing the TA messages. Next, they rated their satisfaction with and the clinical relevance of the TA messages and recorded the final therapy changes.

Results: The TA generated (mostly AT/AF-related) main observations in 49% and programming advice in 33% of the patients. The experts rated 95% of the TA messages as satisfactory and deemed therapy changes necessary in roughly half the patients. Pacemaker changes in AT/AF therapy or general settings were prompted primarily by the diagnostic information stored in the device. Medication changes were mostly led by the symptoms reported by the patient.

Conclusion: This study demonstrates that experienced cardiologists agree with 95% of the observations and programming suggestions that the TA automatically generates. (PACE 2010; 1–10)
http://www3.interscience.wiley.com/journal/123269819/abstract