Why the study?
The study aimed to assess predictors for new-onset atrial fibrillation in patients with cardiac pacemakers, with a particular focus on the impact of hepatic impairment.
Do rate-response pacing mode (DDDR), hepatic impairment, and higher pacing percentages increase the occurrence of new-onset device-detected atrial fibrillation in patients implanted with dual-chamber pacemakers?
Do rate-response pacing mode (DDDR), hepatic impairment, and higher pacing percentages increase the occurrence of new-onset device-detected atrial fibrillation in patients implanted with dual-chamber pacemakers?
In patients receiving dual-chamber pacemakers without prior atrial fibrillation, hepatic impairment, NYHA class III heart failure, DDDR pacing mode, enlarged left atrial dimensions, and higher percentages of atrial and ventricular pacing are significant predictors of new-onset device-detected atrial fibrillation at 9 months.
Answers are grounded in this paper and cite their sources.
Hepatic impairment may signal higher AF risk and complicate anticoagulation; leaves open independent prediction pending prospective studies.
(1) Background: Atrial fibrillation (A Fib) is a common arrhythmia that affects millions of people worldwide and is characterized by irregular and often rapid heartbeats that can cause stroke. The aim of our study was to assess the importance of predictors for the occurrence of atrial fibrillation in patients with cardiac pacemakers and to analyze their impact on these patients, especially the impact of hepatic impairment. (2) Methods: This study is an observational, retrospective study, including 182 patients who were implanted with a dual-chamber pacemaker (DDD), with no known history of A Fib. (3) Results: We identified as predictors for the occurrence of atrial fibrillation in patients with cardiac pacemakers, DDD with rate response mode, NYHA class III of heart failure, as well as the presence of hepatic impairment (HI). Analysis of echocardiographic parameters of the left atrium revealed a larger left atrial volume as well as a larger left atrial area compared to patients who had a much smaller area at baseline and who did not experience any atrial fibrillation at follow-up. The fact that there were no statistically significant differences between the two groups of patients in terms of left atrial ejection fraction at baseline was very interesting. Patients in the A Fib group had a higher percentage of atrial pacing at the 9-month follow-up (86.23 ± 22.19%) compared to patients in the group without A Fib (44.92 ± 29.99%, p < 0.0001) and had a 9-month follow-up rate of A Fib of 25.806% vs. 2.247% in those with a low percentage of atrial pacing (p < 0.0001). The percentage of ventricular pacing at the 9-month follow-up, the observations were almost similar. (4) Conclusions: The importance of pacemakers in detecting subclinical episodes of atrial fibrillation remains crucial for the prevention of embolic events in these patients. Hepatic impairment may be a risk factor for the occurrence of atrial fibrillation in patients with pacemakers, but it can also create significant problems in stroke prevention.
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Târtea et al. (2025) studied this question.
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