Key result
Device-detected atrial fibrillation was associated with a increased risk of composite cardiac outcomes, primarily driven by increased cardiac readmissions.
Why the study?
Atrial fibrillation can cause adverse cardiac consequences, but the association between AF burden and cardiac prognosis is unknown.
Does pacemaker-detected atrial fibrillation burden predict adverse cardiac outcomes in patients with dual-chamber pacemakers?
Cohort (n=204)
No
Does pacemaker-detected atrial fibrillation burden predict adverse cardiac outcomes in patients with dual-chamber pacemakers?
Pacemaker-detected atrial fibrillation, particularly episodes lasting longer than 6 minutes, is associated with an increased risk of adverse cardiac outcomes, primarily driven by heart failure or ACS-related readmissions.
Answers are grounded in this paper and cite their sources.
Device-detected AF signals higher cardiac readmission risk in pacemaker patients; hypothesis-generating, prospective trials needed before guiding interventions.
Background: Atrial fibrillation (AF) might lead to adverse cardiac consequences. The association between AF burden and cardiac prognosis is unknown. Methods and Results: This retrospective cohort study enrolled 204 patients (117 males; age 74.5 ± 11.5 years) who underwent dual-chamber pacemaker implantation in our center from October 2003 to May 2017. During a median follow-up of 66.5 months, AF could be detected in 153 (75%) of the 204 pacemaker patients. Primary endpoint events (composite cardiac readmission, stroke or systemic embolism, and all-cause death) occurred in 83 cases (40.7%). In logistic regression analysis, AF detection was associated with increased risks of composite endpoints [odds ratio (OR) = 2.9, 95% confidence interval (CI): 1.3–6.2, p = 0.007], and the hazard was mainly driven by increased cardiac readmission (OR = 2.2, 95% CI: 1.1–4.7, p = 0.034). No significantly elevated risk for new-onset stroke, systemic embolism, or deaths were found in patients with AF detected than those without AF recorded. AF duration grade of more than 6 min suggested progressively increased composite endpoints (OR = 1.8, 95% CI: 1.2–2.7, p for trend = 0.005), cardiac readmission (OR = 1.8, 95% CI: 1.2–2.7, p for trend = 0.005), especially heart failure or acute coronary syndrome-associated readmission (OR = 1.8, 95% CI: 1.2–2.9, p for trend = 0.010), than those with shorter (<6 min) or no AF episodes. Kaplan–Meier analyses and Cox regression also suggested that episodes of AF more than 6 min predicted future cardiac events. Conclusions: AF detected by pacemakers were common. Higher AF burden predicted more adverse cardiac outcomes and might suggest the intervention of rhythm control in these population.
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Chu et al. (2021) conducted a cohort in Dual-chamber pacemaker implantation (n=204). Device-detected atrial fibrillation vs. No atrial fibrillation detected was evaluated on Composite of cardiac readmission, ischemic stroke or systemic embolism, and all-cause death (OR 2.9, 95% CI 1.3-6.2, p=0.007). Device-detected atrial fibrillation was associated with a increased risk of composite cardiac outcomes, primarily driven by increased cardiac readmissions.
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