Clinical relevance of histograms in the follow-up of DDDR pacemakers

Abstract

As technology has improved over the years, implanted devices designed for pacing therapy have become more and more sophisticated. Due to the development of dual chamber pacemakers with rate-response systems, the treatment of bradyarrhythmia has become more ‘physiological’. Appropriate individualized programming of the pacemaker is both possible and necessary. Information about the intrinsic heart rate and the sensor rate-response of the pacemaker is obligatory for optimal adjustment of the rate-modulated pacemaker. An accurate detection of atrial tachyarrhythmia is mandatory to program the response of the pacemaker to a pathological rate-excess (e.g. by using automatic mode switching). Until now, exercise tests and external telemetry (24-h Holter recording) were the main tools available to obtain this information. Both techniques are time consuming and rather expensive. Moreover, exercise tests do not represent normal daily activity and have a rather low sensitivity for the detection of atrial arrhythmias. Holter recording has the disadvantage of evaluating the heart rhythm during a limited period and can be difficult to interpret because of low P wave signals.