Key result
Prolonged pre-implant P-wave duration linked to ~440% higher risk of worsening AF burden in SSS.
Why the study?
This study aimed to clarify the ability of P-wave duration before pacemaker implantation to predict worsening AF burden after the procedure.
Does prolonged P-wave duration predict worsening atrial fibrillation burden in patients with sick sinus syndrome undergoing pacemaker implantation?
Cohort (n=75)
No
Does prolonged P-wave duration predict worsening atrial fibrillation burden in patients with sick sinus syndrome undergoing pacemaker implantation?
Prolonged P-wave duration (≥108 ms) before pacemaker implantation is a strong independent predictor of worsening atrial fibrillation burden in patients with sick sinus syndrome.
May aid AF risk stratification in sick sinus syndrome; hypothesis-generating and requires prospective validation before practice change.
Background This study aimed to clarify P‐wave duration (PWD) ability before pacemaker implantation to predict worsening atrial fibrillation (AF) burden after the procedure. Methods We retrospectively investigated 75 patients who underwent permanent pacemaker implantation due to sick sinus syndrome (SSS) at Komaki City Hospital between January 2006 and May 2019. Worsening AF burden was defined as an increase in the number of AF episodes, each lasting ≥5.5 hours a day. Results In the study population, 17 patients (23%) had worsening AF burden during the follow‐up period. These patients had significantly longer PWD in lead Ⅱ (117.9 ± 19.9 ms vs 101.3 ± 20.0 ms, P = .002) than the patients without worsening AF burden. The best discriminative cutoff value for PWD in lead Ⅱ was 108 ms (sensitivity, 77%; specificity, 67%). In multivariate analysis, PWD in lead II ≥108 ms (hazard ratio, 5.395; 95% confidence interval, 1.352‐21.523; P = .017) was an independent predictor of worsening AF burden. Patients with PWD in lead II <108 ms showed a significantly higher event‐free rate against worsening AF burden than those with PWD in lead II ≥108 ms (81% vs 9%, P = .005). Conclusions Prolonged PWD before pacemaker implantation was the most important independent predictor of worsening AF burden after the procedure. In patients with SSS, prolonged PWD can be a useful marker for predicting worsening of AF burden after pacemaker implantation.
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Murase et al. (2021) conducted a cohort in Sick sinus syndrome (n=75). P-wave duration ≥108 ms in lead II vs. P-wave duration <108 ms in lead II was evaluated on Worsening atrial fibrillation burden (HR 5.395, 95% CI 1.352-21.523, p=0.017). Prolonged P-wave duration ≥108 ms in lead II before pacemaker implantation independently predicted worsening atrial fibrillation burden in patients with sick sinus syndrome (HR 5.395).
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