Atrial pacing as a new predictor for atrial high rate episodes in patients with dual-chamber pacemaker

Abstract

Introduction and objectivesAtrial and ventricular pacing (AP/VP) have been related to a higher risk of clinical atrial fibrillation (AF). Subclinical AF (SCAF) is detected as atrial high rate episodes by cardiac pacing devices. We aimed to determine whether the percentage of AP/VP is related with the development of SCAF. MethodsFrom February 2012 to September 2015 we recruited consecutive patients with dual chamber pacemakers and no history of AF. SCAF (atrial high rate episodes), clinical AF (electrocardiographically documented) and cardiovascular events were registered. ResultsA total of 249 patients (57% men; 75±9 years) were included. After a mean follow-up of 33±11 months, 38.5% developed SCAF and 10.4% AF. Patients with AP ≥ 50% presented higher risk of SCAF (62.5% vs 32.3%; OR, 3.48; 95%CI, 1.93-6.4; P<.01) and AF (18.7% vs 8.6%; OR, 2.4; 95%CI, 1.05-5.52; P <.05). Patients with VP ≥ 50% had higher risk of SCAF (46.4% vs 31.6%; OR, 1.87; 95%CI, 1.10-3.24; P <.05) and AF (25.9% vs 9.7%; OR, 2.7; 95%CI, 1.13-7.72; P <.05). AP ≥ 50% was an independent predictor for SCAF (HR, 2.44; 95%CI, 1.20-4.97; P=.014). ConclusionsAtrial and ventricular pacing are related with higher risk of developing subclinical and clinical AF in patients with dual-chamber pacemakers and no history of previous AF. Our data suggest, that patients presenting a high percentage of AP should be closely followed during routinely pacemaker check-ups assessing for SCAF.