Diagnostic Blind Spot: Physicians Overlook Atrial Fibrillation in Pacemaker-Dependent Patients

Background: Pacemaker recipients demonstrate a higher prevalence of atrial fibrillation (AF), yet the regular ventricular activation in pacemaker-dependent patients with AF presents a substantial diagnostic challenge.

Methods: A total of 310 medical practitioners completed a brief, validated survey consisting of three electrocardiograms displaying AF with ventricular pacing. Participants were instructed to identify the underlying rhythm.

Results: Cardiologists outperformed all other groups with 69% correct responses, followed by emergency physicians (33%) and internists (24%). The poorest performance was observed among primary care physicians (14%) and medical interns (12%) (p < 0.0001). The comparison between groups revealed a statistically significant difference between cardiologists and non-cardiologists (p < 0.001).

Conclusion: The detection of AF in patients with ventricular-paced rhythm remains a significant diagnostic challenge, with notable gaps even among cardiologists. It is imperative to educate physicians that AF in this context may not present with the typical irregular rhythm. Routine interrogation of cardiac devices in cases where the rhythm is unclear can facilitate a timely and accurate diagnosis of this concealed arrhythmia.