Incidence of Documented Atrial Arrhythmias in Patients with Dual Chamber Cardiac Implantable Devices

Abstract

Abstract Background Atrial fibrillation (AF) is the most common sustained atrial arrhythmia, and is associated with increased risks of morbidity and mortality. Integrated management including anticoagulation therapy in patients with AF is increasingly recognized, but there are still a substantial number of AF patients admitted with stroke, heart failure, and other complications. This can be to some extent due to asymptomatic nature of AF as approximately one-third of patients did not report any symptoms commonly attributable to AF (e.g., palpitations, shortness of breath, or chest pain), leading to a prolonged delay in AF diagnosis and timely initiation of anticoagulation therapy. In many cases, asymptomatic AF is diagnosed only after the onset of complications such as ischemic stroke or congestive heart failure has occurred. Objective This work aims at documenting atrial arrhythmias in patients with dual chamber cardiac implantable devices. Patients and Methods This study included 200 patients who were undergoing follow up of dual chamber cardiac implantable devices. The study was carried out in pacemaker follow up clinics at Ain Shams University hospitals and National Heart Institute. Results According to the results of the current study we concluded diabetes Mellitus, ischemic heart diseases, decreased function (EF ≤ 48%) and dilated LA & LV dimensions (LVIDd >48 mm, LVIDs >41 mm, LA diameter >52 mm), are significant factors associated with AHREs in patients with dual chamber cardiac implantable devices. But unfortunately we cannot assess precisely the impact of AHRE on stroke or thromboembolism development in such patients due to the relatively small number of patients were included in the present study, which may have reduced the detection power and possibly influenced the validity of some results. Conclusion Diabetes Mellitus, ischemic heart diseases, decreased function (EF ≤ 48%) and dilated LA & LV dimensions (LVIDd >48 mm, LVIDs >41 mm, LA diameter >52 mm), are significant factors associated with AHREs in patients with dual chamber cardiac implantable devices. Abbreviations AF: Atrial fibrillation; AHRE: Atrial high rate episodes; AT: Atrial Tachycardia; BMI: Body mass index; CI: Confidence intervals; CIED: Cardiac implantable electronic devices; CRT: Cardiac resynchronization therapy; DDD: Dual chamber Device DM: Diabetes Mellitus; ECG: Electrocardiogram; EF: Ejection Fraction; HbA1c: Hemoglobin A1c; HR: Hazard Ratio; ICD: Implantable cardioverter defibrillator; IHD: Ischemic heart disease; INR: International Normalized Ratio; LA: Left atrium; LVIDd: Left ventricular internal dimensions (Diastole); LVIDs: Left ventricular internal dimensions (Systole); MOST: Mode Selection Trial; OR: Odds ratio; ROC: Receiver operating characteristic curve; AUC: Area Under Curve; SCAF: Subclinical AF