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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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01. History of Cardiology
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08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Do DDD pacemakers increase the incidence of atrial fibrillation?
Session:
Posters 5 - Écran 3 - Arritmologia
Speaker:
Pedro Campos Amador
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.2 Atrial Fibrillation - Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Pedro Campos Amador; Rita Marinheiro; Leonor Parreira; Claudia Lopes; Andreia Cristina Serrano Fernandes; Jose Venancio; Artur Lopes; Dinis Valbom Mesquita; José Maria Farinha; Rui Caria
Abstract
<p>Background: The development of atrial fibrillation (AF) after pacemaker (PM) implantation has been often observed. Therefore, it is reasonable to question if the presence of a lead in the right atrial appendage would increase the risk or protect against this arrhythmia. <br /> <br /> Objective: Compare patients with DDD and VDD PMs regarding the incidence of AF <br /> <br /> Methods: Between January and April of 2018 we observed 543 patients in our pacemaker clinic. We selected 223 consecutive patients with dual chamber PM for atrioventricular block. We excluded those with sick sinus syndrome, prior AF episodes, atrial pacing (AP) ≥ 40% and left ventricular dysfunction. Univariable and multivariable logistic regression models were used to examine the strength of association between risk factors and AF. Cox proportional hazard regression analyses were used to estimate hazard ratios (HR) and 95% confidence intervals (CIs). <br /> <br /> Results: We studied 102 patients with VDD and 121 with DDD PMs, median follow-up of 5.7 (3.1-9.7) years vs. 3.7 (1.6-7.1) years, respectively. Patients with VDD were older (82 [72-86] years vs. 78 [73-84] years, p=0.002) and more frequently female (52.0% vs 37.7%, p=0.031). There were no statistically significant differences between groups for other baseline characteristics (hypertension, diabetes, body mass index, stroke, coronary heart disease, CHA2DS2–VASC score, P wave duration, atrial volume, percentage of ventricular pacing, resting heart rate). The incidence of AF was higher in DDD group (23.1% vs 11.8%, p =0.008). DDD PM increased the risk of atrial fibrillation (HR 2.27, 95% CI 1.08-4.78, p= 0.031) after adjustment for age, gender, hypertension, diabetes, and AP (see figure 1a). The figure 1b displays Kaplan-Meier curves showing that the probability of developing AF over time was higher in patients with DDD PM. <br /> <br /> Conclusion: In this population of patients, DDD PM was associated with higher incidence of AF, as compared with VDD PM. DDD PM was an independent predictor for occurence of AF episodes, during follow-up.</p>
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