Key result
Hypertension is linked to ~3-fold higher risk of new-onset AF after pacemaker implantation.
Why the study?
Risk factors and the prognosis for new-onset AF after dual-chamber pacemaker implantation in elderly patients required investigation.
What are the independent risk factors and prognostic impact on stroke and heart failure hospitalization for new-onset atrial fibrillation in elderly patients after dual-chamber permanent pacemaker implantation?
Cohort (n=322)
No
What are the independent risk factors and prognostic impact on stroke and heart failure hospitalization for new-onset atrial fibrillation in elderly patients after dual-chamber permanent pacemaker implantation?
In elderly patients receiving dual-chamber pacemakers, hypertension, older age, left atrial enlargement, and higher ventricular pacing rates independently predict new-onset AF, which occurs in nearly one-quarter of patients and is associated with increased risks of ischemic stroke and heart failure hospitalization.
Answers are grounded in this paper and cite their sources.
May inform closer AF surveillance after pacemaker implantation; leaves open whether modifying these factors reduces stroke or HF risk.
Objective To retrospectively identify risk factors and the prognosis for new-onset atrial fibrillation (AF) after implantation of dual-chamber pacemakers in elderly patients. Methods Consecutive patients aged ≥ 65 years who underwent their first implantation of a dual-chamber permanent pacemaker in Beijing Anzhen Hospital from October 2013 to May 2016 were enrolled. Their complete programming and follow-up data were recorded. Follow-up end points included new-onset AF and major adverse cardiovascular and cerebrovascular events. Results Altogether, 322 patients were enrolled, with new-onset AF observed in 79 (24.5%) during their follow-up. Multivariable analysis identified four independent predictors of new-onset AF in elderly patients after pacemaker implantation: hypertension (HR = 3.040, 95% CI: 1.09-3.05, P = 0.00); age (HR = 1.966, 95% CI: 1.57-3.68, P = 0.01); left atrial enlargement (HR = 1.645, 95% CI: 1.05-1.25, P = 0.03); high ventricular pacing rate (HR = 1.137, 95% CI: 1.01-1.06, P = 0.01). Univariable analysis indicated that the CHA2DS2-VASc score was also a risk factor for AF (HR = 1.368, 95% CI: 1.178-1.589, P = 0.002), whereas multivariable regression analysis did not. Kaplan-Meier survival analysis showed that the risk for ischemic stroke was significantly higher in the new-onset AF group than in the non-AF group (P < 0.05). Conclusion Hypertension, age, left atrial enlargement, and high ventricular pacing rate were independent predictors of new-onset AF in elderly patients after implantation of a permanent pacemaker. New-onset AF increased the risk for ischemic stroke.
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Chen et al. (2018) conducted a cohort in Sick sinus syndrome and/or atrioventricular block undergoing first dual-chamber permanent pacemaker implantation (n=322). Hypertension (and other baseline risk factors including age, left atrial enlargement, and high ventricular pacing rate) vs. Absence of hypertension / lower risk factor levels was evaluated on New-onset atrial fibrillation (AHRE >5 min with atrial rate >250 bpm or ECG/24h Holter confirmed AF) (HR 3.040, 95% CI 1.09-3.05, p=0.00). Hypertension (HR 3.040), age (HR 1.966), left atrial enlargement (HR 1.645), and high ventricular pacing rate (HR 1.137) independently predicted new-onset AF (24.5%) after pacemaker implantation.
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