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Early Detection and Treatment of Atrial Arrhythmias Alleviates the Arrhythmic Burden in Paced Patients: The SETAM Study
Author(s) -
AMARA WALID,
MONTAGNIER CHRISTIAN,
CHEGGOUR SAÏDA,
BOURSIER MICHEL,
GULLY CLAUDE,
BARNAY CLAUDE,
GEORGER FREDERIC,
DEPLAGNE ANTOINE,
FROMENTIN STEPHANE,
MLOTEK MARCIN,
LAZARUS ARNAUD,
TAÏEB JERÔME
Publication year - 2017
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13062
Subject(s) - medicine , confidence interval , hazard ratio , adverse effect , ambulatory , sinus rhythm , atrial fibrillation , cardiology
Background Remote monitoring (RM) can remotely detect atrial tachyarrhythmias (ATAs). The benefit of RM compared to conventional follow‐up in the detection and management of ATA was assessed in recipients of dual‐chamber pacemakers. Methods The multicenter randomized SETAM study enrolled 595 patients in sinus rhythm with a CHA 2 DS 2 ‐VASc score ≥2, without ATA history and untreated with antiarrhythmics and antithrombotics, randomly assigned to RM (RM‐ON; n = 291) versus ambulatory follow‐up (RM‐OFF; n = 304) during 12.8 ± 3.3 months. ATA occurrence, burden, and management were analyzed together with adverse clinical events. Results Patients were 79 ± 8 years old, 63% men, with a CHA 2 DS 2 ‐VASc score of 3.7± 1.2. ATA were detected in 83 patients (28%) in the RM‐ON versus 66 (22%) in the RM‐OFF group (P = 0.06). The median time between the pacemaker implantation and the first treated ATA was 114 days [44; 241] in the RM‐ON versus 224 days [67; 366] in the RM‐OFF group (hazard ratio [HR] = 0.56; 95% confidence interval [CI]: 0.37–0.86; P = 0.01). Therapies for ATA were initiated in 92 patients and the time to treatment of ATA was shortened by 44% in the RM‐ON group (HR = 0.565; 95% CI: 0.37–0.86; P = 0.01). Over the last 4 months of follow‐up, the mean ATA burden was alleviated by 4 hours/day (18%) in the RM‐ON group. The rate of adverse clinical events was similar in both groups. Conclusion Remotely monitored patients were diagnosed and treated earlier for ATA, and subsequently had a lower ATA burden.