January 1, 2017Circulation JournalOpen Access

Characteristics and Prognosis of Pacemaker-Identified New-Onset Atrial Fibrillation in Japanese People

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Newly implanted pacemaker (n=207). Intervention: Pacemaker-identified new-onset atrial fibrillation vs. No new-onset atrial fibrillation. Primary outcome: Admission due to worsening heart failure (HR 8.87, 95% CI 2.22-35.5, p=0.002).

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Key result

Pacemaker-identified new-onset atrial fibrillation was associated with a significantly increased risk of admission for worsening heart failure (HR 8.87) compared to patients without new-onset AF.

Why the study?

Does pacemaker-identified new-onset atrial fibrillation increase the risk of adverse clinical outcomes in Japanese patients with implanted pacemakers?

Study Design

Type

Observational (n=207)

Multicenter

Structured PICO

Does pacemaker-identified new-onset atrial fibrillation increase the risk of adverse clinical outcomes in Japanese patients with implanted pacemakers?

Population

207 Japanese patients with newly implanted pacemakers and no prior history of atrial fibrillation, followed for a mean of 3.1 years.

Exposure

Pacemaker-identified new-onset atrial fibrillation (defined as atrial high-rate episodes >5 min with a cut-off rate of 180 beats/min)

Comparator

No pacemaker-identified new-onset atrial fibrillation

Outcome

Incidence of all-cause death, stroke, and hospitalization for heart failurehard clinical

Main Result

Hazard Ratio: 8.87 (95% CI 2.22–35.5)

p-value: p=0.002

Pacemaker-identified new-onset atrial fibrillation occurs in approximately 21% of Japanese patients over 3 years and is strongly associated with an increased risk of hospitalization for worsening heart failure.

Limitations

Subclinical AF before pacemaker implantation is difficult to identify, so some patients may have already developed AF prior to implantation.
Single-center study with a relatively small number of analyzed patients.
Medication dose and patient compliance were not analyzed.
Retrospective study design.
Subclinical AF before pacemaker implantation is difficult to identify and might have been missed
Single-center study with a relatively small number of analyzed patients
Medication dose and patient compliance were not analyzed

Implication

Alerts clinicians to monitor for HF decompensation; leaves open whether intervention alters risk in device patients.

Abstract

BACKGROUND: The characteristics and prognosis of implanted pacemaker-identified new-onset atrial fibrillation (AF) in Japanese people has not been well evaluated. METHODS AND RESULTS: -VASc score (3.00±1.39 vs. 2.26±1.19, P<0.001) compared with those without new-onset AF. On Cox regression analysis only age at implantation was significantly correlated with new-onset AF. Interestingly, the incidence of hospitalization due to heart failure was significantly higher in the new-onset AF than in the without new-onset AF group. CONCLUSIONS: -VASc scores developed new-onset AF during a mean follow-up of 3.1 years; and pacemaker-identified AF was associated with an increased risk of worsening heart failure.

Discussion

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Cite This Study

Ogino et al. (2017) conducted an observational in Newly implanted pacemaker (n=207). Pacemaker-identified new-onset atrial fibrillation vs. No new-onset atrial fibrillation was evaluated on Admission due to worsening heart failure (HR 8.87, 95% CI 2.22-35.5, p=0.002). Pacemaker-identified new-onset atrial fibrillation was associated with a significantly increased risk of admission for worsening heart failure (HR 8.87) compared to patients without new-onset AF.

synapsesocial.com/papers/6a6f265126770c2b8ddfdc76 https://doi.org/10.1253/circj.cj-16-1018