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Long-term predictors of new onset atrial fibrillation after dual chamber pacemaker implantation
Session:
CO2 - Arritmias Supraventriculares
Speaker:
Vera Vaz Ferreira
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.2 Atrial Fibrillation - Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Vera Ferreira; André Viveiros Monteiro; Guilherme Portugal; Pedro Silva Cunha; Ana Lousinha; Paulo Osório; Bruno Tereno Valente; Susana Covas; Manuel Brás; Alice Areias; Alexandra Castelo; Pedro Garcia Brás; Rui Cruz Ferreira; Mário Martins Oliveira
Abstract
<p>Preserving atrioventricular synchrony has been accepted as a significant advantage of atrial and dual-chamber (DDD) pacing. However, little is known about the incidence of atrial fibrillation (AF) after DDD implantation and its prognostic predictors in long-term follow-up.</p> <p><strong>Purpose:</strong> To determine the incidence of new AF episodes and to identify risk factors and predictors for new-onset AF and all-cause mortality after implantation of DDD pacemaker (PM).</p> <p><strong>Population and Methods:</strong> 713 consecutive patients (P) who underwent DDD PM implantation, due to AV block (AVB) or sinus node disease (SND), with no prior history of AF, from 2011 to 2015. Through periodic PM interrogation, occurrence of AF (“automatic mode switch” episodes with documented AF), switch to ventricular pacing (VVIR), pacing site (apical or septal) and cumulative right ventricular (RV) pacing % were analysed.</p> <p><strong>Results: </strong>Follow-up data was available for 669 P (93.8%) for a mean follow-up (FU) time of 47.8±22.7 months. Mean age was 72.9±10.8 years with 60.1% male. New occurrence of AF was observed in 345 P (51.6%); 45.7% of them were consequently anticoagulated. Median time to 1<sup>st</sup> AF episode since implantation was 21.6 months. In 50.9% of the cases it lasted ≥1hour. In univariate analysis, 1<sup>st</sup> AF episode lasting more than 1 hour and existence of at least one episode longer than 24 hours were directly related to switch to VVIR (p<0.0005), as well as prescription of anticoagulation (p=0.001). Compared to non-AF P, those with AF were older (74.0±9.9 years vs. 71.8±11.7 years; p=0.008), had higher prevalence of SND (50.0% vs. 40.20%; p=0.015), had superior % of RV pacing (65.9±39.3% vs. 58.3±44.3%; p=0.021) and had more frequently RV apical pacing (70.1% vs. 57.3%; p=0.001). The prevalence of hypertension, diabetes mellitus and dyslipidemia were similar in the two groups. With multivariable Cox-regression, age (HR 1.02; p=0.017), SND (HR 1.49; p=0.01), admission for heart failure (HR 1.55; p=0.012) and % of RV pacing (HR 1.01; p=0.003) were significantly associated with the incidence of AF. Predictors of all-cause mortality in Cox regression were the occurrence of AF in 1<sup>st</sup> FU (HR 1.67; p=0.018) and % RV pacing (HR 1.01; p=0.043).</p> <p><strong>Conclusions:</strong> New onset AF is a frequent finding after DDD PM implantation and is associated with all-cause mortality in long-term. Age, admission for heart failure, SND and % of RV pacing were independent predictors for AF during follow-up.</p>
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