Abstract 3262: De Novo Atrial Fibrillation in Patients with Dual Chamber Pacemakers
Background: Brief atrial high rate episodes (AHREs) of even 5 minutes duration, as detected by pacemaker (PPM) diagnostics, are a reliable surrogate for atrial fibrillation (AF) and potentially identify patients at increased risk for stroke and death. However, the incidence and predictors of de novo AF following dual chamber PPM implantation are unknown.
Methods: We retrospectively evaluated 127 patients (71 male; 76 ± 11 years) without documented AF who underwent PPM implantation for management of sinus node dysfunction. Information regarding patient demographics, cardiovascular diseases, and medication history was obtained. The cumulative percentage of right ventricular pacing (Cum VP) was determined.
Results: During a mean follow-up of 599 ± 353 days, 33 (26%) patients had an AHRE ≥ 5 minutes. Age, gender, ejection fraction, co-morbid medical conditions, use of medications, and burden of atrial pacing were similar between patients with and without AHREs during the follow-up period. The only significant predictor of an AHRE was ≥ 50% Cum VP (RR 2.2; CI [1.1–4.8]; p = 0.03, Figure⇓). The 1- and 2-year incidence of an AHRE < 5 minutes was 13% and 17% in patients with ≥ 50% Cum VP as compared to 29% and 32% in patients with ≥ 50% Cum VP.
Conclusions: Cumulative right ventricular pacing ≥ 50% was the sole significant predictor of de novo AF (defined as an AHRE ≥ 5 minutes) in patients with sinus node dysfunction following dual chamber PPM implantation and is associated with a more than two-fold increased risk of AF. The routine use of novel pacing strategies that minimize right ventricular pacing merits prospective investigation as a means of reducing the incidence of de novo AF in this population.