PACEMAKER PATIENT-TRIGGERED EVENT RECORDING - ACCURACY, UTILITY, AND COST FOR THE PACEMAKER FOLLOW-UP CLINIC

Many pacemaker patients have vague symptoms following implantation. It is often difficult for the physician to ascertain if they are cardiac in origin. A new pacemaker feature has been introduced, Patient-Trigg ered Event Records (PTER), to help the physician with this diagnosis. The PTER is a continuously running event record which stores the cardi ac rhythm and rate. Brief application of a magnet will transfer the re cord into the device's memory. The data recorded will be the 97 events prior to the magnet application and the 30 events following magnet re moval. The exact state of pacing (atrial and ventricular sensing/pacin g, or premature ventricular events) and the rate of the ventricular ev ents will be graphically displayed by the programmer for all 127 event s. Thus, the exact pacer and cardiac rhythm can be determined during t he period of the symptomatic episode. A total of three PTER's can be s tored within the device. If a fourth is recorded, it will replace the oldest record. Three pacemakers with the PTER feature were tested in v itro with five different simulated cardiac rhythms. A beat-by-beat com parison between the PTER and the 15 simulated test rhythms revealed a 100 % accurate documentation by PTER. Sixteen pacemaker patients which have the PTER feature were monitored using a King of Hearts(TM) for a total of 43 symptomatic events. The PTER records produced clinically relevant information 98 % of the time while the King of Hearts(TM) pro duced clinically relevant information 82 % of the time. A comparison o f costs of the two different methods of monitoring these patients, was $2,432 versus $4,480 for the PTER and loop event monitor respectively . The PTER is an accurate, lower cost method for monitoring and diagno sing symptomatic pacemaker patients. The PTER can be used as the first diagnostic tool in troubleshooting patients with paroxysmal symptoms in the pacemaker clinic population.