Abstract
BackgroundThe management of patients with non-valvular atrial fibrillation (NVAF) with rate-lowering or anti-arrhythmic drugs has markedly changed over the last decade, but it is unknown how these changes have affected patients with NVAF with a permanent pacemaker (PPM).MethodsThrough Danish nationwide registries, patients with NVAF and a PPM were identified from 2001 to 2012. Changes in concomitant pharmacotherapy and comorbidities were tested using the Cochran–Armitage trend test and linear regression. Patients with NVAF were identified to calculate the proportional amount of PPM implants.ResultsA total of 12,231 NVAF patients with a PPM were included in the study, 55.6% of which were men. Median age was 78 years (interquartile range 70–84). From 2001 to 2012, the number of NVAF patients with a PPM increased from 850 to 1344, while the number of NVAF patients increased from 67,478 to 127,261. Thus, the proportional amount of NVAF patients with a PPM decreased from 1.3% to 1.1% (p = 0.015). Overall 45.9% had atrial fibrillation (AF) duration less than one year and the proportion declined from 55.5% to 42.4% (p <0.001). Diabetes mellitus increased from 7.2% to 16.8% (p <0.001). Heart failure (HF) decreased from 36.7% to 29.3% (p = 0.010) and ischemic heart disease (IHD) decreased from 32.4% to 26.1% (p <0.001). Beta-blocker use increased from 38.1% to 58.0% (p <0.001), while digoxin and anti-arrhythmic drug use decreased over time.ConclusionFrom 2001 to 2012, the absolute number of NVAF patients with a PPM increased while the proportional amount decreased. The number of NVAF patients receiving a PPM within one year of AF diagnosis decreased. The prevalence of DM increased, while the prevalence of HF and IHD was high but decreasing. The use of beta-blockers increased markedly, while use of digoxin and anti-arrhythmic drugs decreased over time.
Highlights
Treatment strategies of non-valvular atrial fibrillation (NVAF) have changed over the last decade, potentially resulting in changes to the need for permanent pacemaker (PPM) implantation [1,2,3,4]
A total of 12,231 NVAF patients with a PPM were included in the study, 55.6% of which were men
The proportional amount of NVAF patients with a PPM decreased from 1.3% to 1.1% (p = 0.015)
Summary
Treatment strategies of non-valvular atrial fibrillation (NVAF) have changed over the last decade, potentially resulting in changes to the need for permanent pacemaker (PPM) implantation [1,2,3,4]. It is unknown how the patients with NVAF and PPM are treated at the time of device implantation. It has not been described whether the temporal changes in comorbidity burden and use of pharmacotherapy during the last decade among these patients reflect the general trends among NVAF patients. The management of patients with non-valvular atrial fibrillation (NVAF) with rate-lowering or anti-arrhythmic drugs has markedly changed over the last decade, but it is unknown how these changes have affected patients with NVAF with a permanent pacemaker (PPM)
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