Diagnosis of atrial fibrillation by remote monitoring Copy Copy


  • 88-year-old man
  • Evia DR pacemaker (Biotronik) for sinus dysfunction with prolonged PR interval
  • DDD mode
  • asymptomatic
  • remote monitoring yellow alert message for occurrence of an episode of atrial arrhythmia



  • yellow alert in the setting an atrial load above the set limit and of a classified long atrial episode
  • the atrial arrhythmia status shows that the atrial arrhythmia appears permanent over the past 24 hours
  • the plot shows that the atrial arrhythmia is permanent since the outset of this episode with mode switching
  • HF Monitor status shows that once the atrial arrhythmia had started, the percentage of ventricular pacing had decreased while the ventricular rate had slightly increased and that the patient’s activity had decreased indicating a possible poor tolerance to the arrhythmia
  • the tracing confirms the diagnosis of atrial fibrillation



  • AF is the most common form of arrhythmia in pacemaker-implanted patients and is associated with increased morbidity and mortality
  • one of the major interests of remote monitoring is optimizing the management of patients with AF episodes
  • AF is associated with 2 principal risks: poor hemodynamic tolerance and increased thromboembolic risk
  • remote monitoring allows an early diagnosis of arrhythmia, particularly asymptomatic episodes, and allows the adjustment of antiarrhythmic medical treatment and the rapid introduction of anticoagulant therapy
  • in a patient with atrial arrhythmia, irrespective of the chosen therapeutic strategy, remote monitoring allows an optimization of the follow-up with 1) regular analysis of the mean rate and the maximum rate for the rate control strategy, or 2) evidence of possible recurrences for the rhythm control strategy
  • the report reveals the AF load, the number of episodes and mode switches, as well as provides histograms, atrial and ventricular rate curves, and pacing percentages
  • the EGM confirms or infirms the diagnosis of atrial arrhythmia (versus far-field oversensing, noise oversensing); a false diagnosis of AF may lead to an unnecessary introduction of anticoagulant therapy