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The risk factors of new-onset atrial fibrillation after pacemaker implantation

Risikofaktoren für ein neu auftretendes Vorhofflimmern nach Schrittmacherimplantation

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Abstract

Objective

The aim of this study was to determine the incidence of newly detected atrial fibrillation (AF) in patients following dual-chamber pacemaker (PPM) implantation and to define the clinical predictors of new-onset AF in a Chinese cohort.

Methods

A total of 219 patients without documented AF that underwent dual-chamber PPM implantation for sick sinus syndrome (SSS) (n = 88) or atrioventricular block (AVB) (n = 131) were prospectively studied. All patients were invited to follow-up at 1 month, 3 months and 6 months after the pacemaker implantation procedure, and once every 6 months thereafter. An atrial high-rate episode (AHRE) ≥5 min and an atrial rate ≥180 bpm was defined as AF.

Results

During follow-up of 884 ± 180 days, AF was detected in 56 (26%) patients. Using Kaplan-Meier survival curves with Log-rank test, SSS patients with a cumulative percentage of ventricular pacing (Cum % VP) ≥60% had a significantly higher rate of new-onset AF compared to AVB patients (p = 0.026) and SSS patients with Cum % VP <60% (p = 0.018). On multivariate Cox regression analysis, higher Cum % VP independently predicted higher morbidity of newly detected AF (hazard ratio [HR] 1.01; confidence interval [CI] 1.00 ~ 1.02; p = 0.035) among SSS patients. Larger left atrial (LA) dimension was a predictor of newly detected AF (HR 1.06; CI 1.01 ~ 1.14; p = 0.046) in AVB patients.

Conclusion

The incidence of AF following dual-chamber PPM implantation was relatively high in this Chinese cohort. High Cum % VP and larger LA dimension could independently predict new-onset AF after dual-chamber PPM implantation in SSS and AVB patients, respectively.

Zusammenfassung

Ziel

Ziel der vorliegenden Studie war es, die Inzidenz eines neu diagnostizierten Vorhofflimmerns (VHF) bei Patienten nach Implantation eines Zweikammerschrittmachers („permanent pacemaker“ [PPM]) zu bestimmen und die klinischen Prädiktoren des neu auftretenden VHF in einer chinesischen Kohorte zu ermitteln.

Methoden

Insgesamt 219 Patienten ohne dokumentiertes VHF, bei denen wegen eines Sinusknotensyndroms (SKS; n = 88) oder atrioventrikulären Blocks (AVB; n = 131) eine Zwei-Kammer-PPM-Implantation erfolgte, wurden prospektiv untersucht. Alle Patienten wurden zu einer Follow-up-Untersuchung 1, 3 und 6 Monate nach Schrittmacherimplantation eingeladen, danach alle 6 Monate. Eine atriale Hochfrequenzepisode (AHRE) ≥5 min und eine atriale Frequenz ≥180 bpm wurden als VHF definiert.

Ergebnisse

Im Follow-up von 884 ± 180 Tagen wurde ein VHF bei 56 Patienten (26 %) festgestellt. Unter Betrachtung von Kaplan-Meier-Überlebenskurven mit log-Rang-Test hatten SKS-Patienten mit einem kumulativen Anteil ventrikulärer Stimulation (kum % VS) ≥60 % eine signifikant höhere Rate an neu auftretendem VHF als AVB-Patienten (p = 0,026) und als SKS-Patienten mit kum % VS <60 % (p = 0,018). In der multivariaten Cox-Regressions-Analyse sagte ein höherer kum % VS unter SKS-Patienten unabhängig eine höhere Morbidität durch ein neu diagnostiziertes VHF voraus (Hazard Ratio 1,01; Konfidenzintervall 1,00–1,02; p = 0,035). Eine größere linksatriale (LA) Abmessung war bei AVB-Patienten ein Prädiktor des neu diagnostizierten VHF (Hazard Ratio 1,06; Konfidenzintervall 1,01–1,14; p = 0,046).

Schlussfolgerung

Die Inzidenz des VHF nach Zwei-Kammer-PPM-Implantation war in der hier untersuchten chinesischen Kohorte relativ hoch. Ein hoher kum % VS bzw. eine große LA-Abmessung konnte unabhängig das neu auftretende VHF nach Zwei-Kammer-PPM-Implantation bei SKS- bzw. AVB-Patienten vorhersagen.

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Acknowledgements

This study was supported by BIOTRONIK, St. Jude, and Boston Scientific. Zhi Wei, Xiaodan Jin, and Qing Wang were the technical sales representatives and they responsible for saving and printing pacemaker data. The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China

    Zhaodi Wu

  2. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China

    Xueying Chen, Junbo Ge & Yangang Su

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  1. Zhaodi Wu
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  2. Xueying Chen
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  3. Junbo Ge
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  4. Yangang Su
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Contributions

ZD collected the patient data, drafted the manuscript, and performed the statistical analysis. XY performed and examined the statistical analysis and drafted parts of the manuscript. XY and YG were the surgeons, while YG and JB conceived the study, participated in its design and coordination, and modified the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yangang Su.

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Conflict of interest

Z. Wu, X. Chen, J. Ge, and Y. Su declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

Z. Wu and X. Chen are both first authors and contributed equally to this article.

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Wu, Z., Chen, X., Ge, J. et al. The risk factors of new-onset atrial fibrillation after pacemaker implantation. Herz 46 (Suppl 1), 61–68 (2021). https://doi.org/10.1007/s00059-019-04869-z

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  • DOI: https://doi.org/10.1007/s00059-019-04869-z

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