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Progression from paroxysmal to persistent atrial fibrillation in pacemaker patients with tachycardia–bradycardia syndrome: a multicenter study

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Abstract

Progression from paroxysmal to persistent atrial fibrillation (AF) is occasionally encountered in patients with previous pacemaker implantation (PMI) for the treatment of tachycardia–bradycardia syndrome (TBS). We aimed to determine the rate of its incidence occurring within the early years after PMI and the predictors. We studied TBS patients who received PMI at 5 core cardiovascular centers. The end point was a conversion from paroxysmal to persistent AF. We extracted 342 TBS patients out of 2579 undergoing PMI. During 5 ± 3.1 years of follow-up, 114 (33.3%) reached the end point. The time to the end point was 2.9 ± 2.7 years. The event rates within a year and 3 years after the PMI were 8.8% and 19.6%, respectively. In the multivariate hazard analyses, hypertension (hazard ratio [HR] 3.2, P = 0.03) and congestive heart failure (HR 2.1, P = 0.04) were found to be independent predictors of the end point occurring within a year after the PMI. Congestive heart failure (HR 1.82, P = 0.04), left atrial diameter of ≥ 40 mm (HR 4.55, P < 0.001), and the use of antiarrhythmic agents (HR 0.58, P = 0.04) were independently associated with the 3-year end point. Prediction models including combinations of those 4 parameters for the 1- and 3-year incidence both exhibited a modest risk discrimination (both c-statistics 0.71). In conclusion, early progression from paroxysmal to persistent AF was less frequent than expected in the TBS patients with PMI. Factors related to atrial remodeling and no use of antiarrhythmic drugs may facilitate the progression.

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Authors and Affiliations

  1. Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, 722-8508, Japan

    Naoto Oguri, Akinori Sairaku & Nobuyuki Morishima

  2. Department of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan

    Naoto Oguri, Yasuhiko Hayashi & Yuji Muraoka

  3. Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan

    Naoto Oguri & Yukiko Nakano

  4. Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

    Shunsuke Tomomori

  5. Department of Cardiology, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan

    Takenori Okada

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  1. Naoto Oguri
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  2. Akinori Sairaku
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  3. Nobuyuki Morishima
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  4. Yasuhiko Hayashi
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Correspondence to Akinori Sairaku.

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Oguri, N., Sairaku, A., Morishima, N. et al. Progression from paroxysmal to persistent atrial fibrillation in pacemaker patients with tachycardia–bradycardia syndrome: a multicenter study. Heart Vessels 38, 1149–1155 (2023). https://doi.org/10.1007/s00380-023-02266-5

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