Predictors of Recurrent Atrial Fibrillation Using Mode Switch Quantification

Phillip Ruisi; John N Makaryus; John N Catanzaro; Michael Ruisi; Anthony Cedrone; Amgad N Makaryus; Erik Altman; Ram Jadonath; Stuart Beldner

doi:10.4021/cr292w

Predictors of Recurrent Atrial Fibrillation Using Mode Switch Quantification

Cardiol Res. 2013 Oct;4(4-5):135-138. doi: 10.4021/cr292w. Epub 2013 Oct 15.

Authors

Phillip Ruisi¹, John N Makaryus², John N Catanzaro³, Michael Ruisi⁴, Anthony Cedrone², Amgad N Makaryus², Erik Altman², Ram Jadonath², Stuart Beldner²

Affiliations

¹ Rhode Island Hospital/Brown University, Providence, RI 02903, USA.
² Hofstra North Shore-LIJ School of Medicine Department of Cardiology, North Shore University Hospital, Manhasset, NY 11030, USA.
³ Johns Hopkins University Department of Cardiology/Division of Electrophysiology, USA.
⁴ Beth Israel Medical Center, Department of Cardiology, First Avenue at 16th Street, New York, NY 10003, USA.

PMID: 28352435
PMCID: PMC5358197
DOI: 10.4021/cr292w

Abstract

Background: The efficacy of mode switching to predict atrial fibrillation has been established in the literature. There have been few studies investigating the incidence and clinical implication of mode switch episodes quantified from implantable cardioverter defibrillator and pacemaker interrogation. We sought to investigate the incidence of mode switch recurrence in patients with implantable cardioverter defibrillators and permanent pacemakers.

Methods: Mode switch was defined as any occurrence documented during device interrogation after the date of implantation. Clinical predictors (age, gender, hypertension, diabetes, syncope, atrial fibrillation (AF)), and medications were analyzed to determine association with single and recurrent mode switch occurrences.

Results: There were 21 patients experiencing a mode switch event, identified from a group of 54 patients (42 males; mean age 70 ± 12 years; mean follow-up 29.1 ± 22 months (3.4 - 81.4 months)). All but two patients were receiving medical therapy including beta blockers, statins, ace-inhibitors, and anti-arrhythmics. There were 21 subjects who experienced at least one mode switch during their follow-up and 33 subjects who never experienced a mode switch during their follow-up time. The median time to first mode switch from device implantation was 39.3 months. Risk factors individually associated with any mode switch episode included: diabetes (DM) (P < 0.04) and use of digitalis (P = 0.02). Subjects who had a history of DM were 5 times more likely to have at least one mode switch occurrence. There was a significantly higher rate of mode switch among patients who were diabetic than patients who were not (3.7 per follow-up month ± 5.3 vs. 0.98 per follow-up month ± 2.02; P = 0.02). There was a significantly higher rate of mode switch among patients who were on digitalis than those who were not (3.1 per follow-up month ± 4.3 vs. 0.73 per follow-up month ± 1.9; P = 0.02).

Conclusion: The main factors associated with any mode switch are having a history of diabetes and digitalis use. Those patients who are diabetics and those on digitalis may warrant closer observation and management for the development of atrial fibrillation.

Keywords: Atrial fibrillation; Cardioverter defibrillator; Mode switch; Permanent pacemaker.