Abstract 14028: Predictors of Atrial Fibrillation Free Survival in Patients With Implantable Cardiac Devices

Abstract

Introduction: Improvement of atrial fibrillation (AF) burden can be occasionally observed after pacemaker (PM) implant in patients with tachy-brady syndrome. On the other hand, patients may develop AF after the implant, even without prior history. We studied whether pre-implant parameters affect the risk of death or AF after device implant. Methods Data from 200 consecutive patients who underwent Medtronic dual (DDD) or triple chamber/cardiac resynchronization therapy (CRT) PM or ICD implants were analyzed. Pre-implant data included demographics, vitals, medications, comorbidities, labs, EKG, characteristics of any prior AF, echocardiographic parameters, and planned device type. Follow-up duration was planned as 12 months; survival and AF data (episodes >5 minutes) were collected from device follow-up data. Survival analysis was performed for death and first AF occurrence. Results Average age was 75±10 years, 37% were female. Comorbidities included history of AF (26% paroxysmal, 13.5% persistent), coronary artery disease 48.5%, hypertension 83.5%, diabetes 37.5%, sleep apnea 26%, drug or alcohol abuse 12.5%, heart failure 43%, prior cerebrovascular event 9.5%. PM was implanted in 70%, ICD in 30% of patients; DDD devices in 83.5%, CRT in 16.5%.Follow-up duration was 338±111 days, mortality was 13%, 38.5% of patients had new onset or recurrent AF. There was no difference in mortality between the PM vs. ICD group (11.4% vs. 16.7%, p=0.597) and the DDD vs. CRT group (12.6% vs. 15.2%, p=0.781). The cumulative AF incidence was higher in the PM vs. ICD group (46.7% vs. 21.7%, p=0.037) and in the DDD vs. CRT group (41.9% vs. 21.2%, p=0.039). Conclusion: The type of implanted device, guided by pre-implant clinical parameters affects post-implant AF occurrence. Although ICDs and CRT are utilized in sicker patients, these groups had better AF outcomes - beneficial effects of cardiac resynchronization and routine use of goal-directed medical therapy in these patients prior to and after the implant may play a role.