Abstract
Persistent atrial fibrillation (PeAF) predictors after dual-chamber pacemaker (PM) implantation remain unclear. We sought to determine these predictors and establish an integrated scoring model. Data were retrospectively reviewed for 649 patients (63.8 ± 12.3 years, 48.6% male, mean CHA2DS2–VASC score 2.7 ± 2.0) undergoing dual-chamber PM implantation. PeAF was defined as documented AF on two consecutive electrocardiograms acquired ≥7 days apart. During a 7.1-year median follow-up (interquartile range 4.5–10.1 years), 67 (10.3%) patients had PeAF. Multivariable analysis showed the following independent predictors of future PeAF: ischemic stroke or transient ischemic accident history (hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.03–3.50, p = 0.040), atrial fibrillation/flutter history (HR 1.80, 95% CI 1.01–3.20, p = 0.046), sinus node disease (HR 2.24, 95% CI 1.16–4.35, p = 0.016), left atrial enlargement (>45 mm, HR 2.14, 95% CI 1.26–3.63, p = 0.005), and time in automatic mode switching >1% at first follow-up interrogation (HR 2.58, 95% CI 1.51–4.42, p < 0.001). An integrated scoring model combining these predictors showed good discrimination performance at the seven-year follow-up. (C-statistic 0.716, 95% CI 0.629–0.802, p < 0.001). Significantly greater seven-year PeAF incidences were seen in patients with higher scores (2–5) than in those with lower scores (0–1) (22.8% ± 3.8% vs. 5.3% ± 1.7%, p < 0.001). In conclusion, an integrated scoring model combining clinical, echocardiographic, and electrocardiographic characteristics is useful for predicting future PeAF in patients with a dual-chamber PM.
Highlights
Persistent/permanent atrial fibrillation (PeAF) is a clinically important atrial arrhythmia seen after the implantation of a permanent pacemaker (PM)
An integrated scoring model combining clinical, echocardiographic, and electrocardiographic characteristics is useful for predicting future PeAF in patients with a dual-chamber PM
Atrial fibrillation (AF) after PM implantation is progressive in nature [2,4,7,8,9], and some previous studies have reported that prolonged duration of AF after PM is associated with increased risk of mortality, stroke, or systemic embolism [6,10,11]
Summary
Persistent/permanent atrial fibrillation (PeAF) is a clinically important atrial arrhythmia seen after the implantation of a permanent pacemaker (PM). Some previous studies have suggested that predictors of future PeAF include a prior history of atrial arrhythmia [1,3,5,14], sinus node disease (SND) [1], the cumulative percentage of ventricular pacing [14], left atrial enlargement (LAE), or decreased LA function [15,16], most of these studies were limited by short duration of follow-up or limited data confined to the patient’s clinical characteristics and baseline evaluations
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