Active atrial lead fixation was significantly associated with the presence of atrial high-rate episodes at 3 months post-pacemaker implantation (OR 5.36; 95% CI 1.43-20.07; P<0.05).
Observational (n=110)
Does active atrial lead fixation and recent pacemaker implantation increase the incidence of AHREs and silent ischaemic brain lesions in patients with pacemakers and no history of AF?
AHREs frequently occur in the first 3 months after pacemaker implantation, particularly with active lead fixation, but may not be associated with an increased risk of silent ischaemic brain lesions.
Effect estimate: OR 5.36 (95% CI 1.43-20.07)
p-value: p=< 0.05
Aims: Atrial high-rate episodes (AHREs) compatible with silent AF detected in pacemakers (PM) are related to an increased risk of stroke and silent ischaemic brain lesions (IBL) on CT scan. AHREs soon after PM implantation could be related with the procedure itself and the prognosis might be different. Methods and results: We analysed the incidence of AHREs >5 min and the presence of silent IBL in 110 patients (56% men, aged 75 ± 9 year-old) with PM and no history of AF, in relation to time from implantation (≤3 months vs. >3 months) and the atrial lead fixation (LF) (active vs. passive). Mean CHADS2 and CHA2DS2VASc scores were 1.9 ± 1.2 and 3.5 ± 1.5, respectively. Time from implantation was ≤3 months in 88 patients (80%). Active LF was used in 55 patients (50%). After 24 ± 9 months, AHREs were present in 40 patients (36.4%). CT-scan showed silent IBL in 26 patients (23.6%). The presence of AHREs at 3 months was more frequent in the patients with recent PM implantation (17% vs. 4.5%, P = 0.09) and significantly related to active LF (OR 5.36, 1.43-20.07; P < 0.05). The presence of silent IBL was related to the detection of AHREs during follow up (OR 3.12, 1.29-7.97; P < 0.05) but not with AHREs at first 3 months (OR 1.58, 0.49-5.05; P = 0.44). Conclusions: AHREs occur frequently during the first 3 months after PM implantation and could be related with procedure itself and the use of active LF. AHREs in this period might not be related to worse outcomes and should be interpreted cautiously.
Benezet‐Mazuecos et al. (Mon,) conducted a observational in Pacemaker implantation without history of atrial fibrillation (n=110). Active atrial lead fixation vs. Passive atrial lead fixation was evaluated on Presence of atrial high-rate episodes (AHREs) at 3 months (OR 5.36, 95% CI 1.43-20.07, p=< 0.05). Active atrial lead fixation was significantly associated with the presence of atrial high-rate episodes at 3 months post-pacemaker implantation (OR 5.36; 95% CI 1.43-20.07; P<0.05).
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