Incidence of new onset atrial fibrillation in patients with permanent pacemakers and the relation to the pacing mode

Pan

Chinese Medical Journal

et al. 2016

Background:Atrial fibrillation (AF) is the most frequent tachyarrhythmia in patients with a permanent pacemaker. Angiotensin II receptor antagonists have a protective effect against the occurrence of AF in patients with heart diseases. This study aimed to assess the effectiveness of olmesartan in the prevention of new-onset AF and AF burden in atrioventricular block (AVB) patients with dual-chamber (DDD) pacemaker implantation.Methods:This was a single-center, prospective, randomized, single-blind, controlled clinical study. A total of 116 AVB patients, who received DDD pacemakers implantation with the percentage of ventricular pacing (VP%) ≥40% from April 22, 2011 to December 24, 2012, were prospectively randomized to olmesartan group (20 mg per day; n = 57) or control group (n = 59). Patients were followed up using pacemaker programming, 12-lead electrocardiography in the intrinsic sinus rhythm, laboratory examinations, and transthoracic echocardiography at 24 months. Atrial high rate events (AHREs) were defined as 180 beats/min over a minimum of 5 min. AF burden was calculated by the number of hours with AHREs divided by the number of measurement hours.Results:Ten (17.5%) patients in the olmesartan group and 24 patients (40.7%) in the control group occurred new-onset AF, and the difference between two groups was statistically significant (P = 0.04). AF burden was lower in olmesartan group than that in control group (8.02 ± 3.10% vs. 13.66 ± 6.14%, P = 0.04). There were no significant differences in mean days to the first occurrence of AHREs and mean cumulative numbers of AHREs between two groups (P = 0.89 and P = 0.42, respectively). Moreover, olmesartan group had smaller values of maximal P-wave durations and P-wave dispersion (PD) after 24 months follow-up compared with the control group (109.5 ± 7.4 ms vs. 113.4 ± 7.1 ms, P = 0.00; and 40.6 ± 4.5 ms vs. 43.3 ± 4.4 ms, P = 0.02, respectively). Left ventricular end-diastolic diameter and left ventricular ejection fraction were not significantly different between two groups (both P > 0.05).Conclusion:This study suggested that 24-month of olmesartan therapy could reduce new-onset AF and AF burden in patients with DDD pacemakers.Clinical Trial Registration:ChiCTR-TRC-12004443; http://www.chictrdb.org.

Section: Discussionmentioning

confidence: 99%

Olmesartan Reduces New-onset Atrial Fibrillation and Atrial Fibrillation Burden after Dual-chamber Pacemaker Implantation in Atrioventricular Block Patients

Pan

Chinese Medical Journal

et al. 2016

“…A 10-year follow-up study showed that the incidence of AF was 85.7% in VVI mode compared to 37.4% in non-VVI mode, which confirmed that RVP is more likely to induce AF than AAI or DDD pacing. 90 Several pacemaker companies have successively developed various functions to reduce RVP, such as AV Search+, Managed Ventricular Pacing (MVP), ventricular intrinsic preference algorithm, and dynamic AV delay (Fig. 2).…”

Section: Reducing the Percentage Of Rvpmentioning

confidence: 99%

Review of the epidemiology, pathogenesis and prevention of atrial fibrillation after pacemaker implantation

Wu¹,

Xu²,

Tu³

et al. 2023

Adv Clin Exp Med

Cardiac pacemaker implantation is an important treatment for symptomatic bradycardia. However, epidemiological data show that the incidence of atrial fibrillation (AF) is significantly higher in patients with implanted pacemakers than in the general population, which may be related to the preoperative presence of multiple risk factors for AF, improvement of diagnostic sensitivity and the pacemaker itself. The pathogenesis of AF after the implantation of pacemaker is related to cardiac electrical remodeling, structural remodeling, inflammation, and autonomic nervous disorder, which are induced by the pacemaker. Moreover, different pacing modes and pacing sites have various effects on the pathogenesis of postoperative AF. Recent studies have reported that reducing the proportion of ventricular pacing, improving the pacing site and setting up special pacing procedures might be highly useful in prevention of AF after pacemaker implantation. This article reviews the epidemiology, pathogenesis, influencing factors, and preventive measures regarding AF after pacemaker surgery.

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

“…Right ventricular pacing has been shown to lead to asynchronous left ventricular contraction papillary muscle dysfunction and left atrial enlargement. 14 Patients with AL-CA are more likely to have cardiac electrophysiological dysfunction and, thus, AF. 15 The presence of an implantable defibrillator usually signifies advanced cardiomyopathy, and the associated structural abnormalities such a left atrial enlargement could explain the enhanced risk of AF.…”

Section: Figure 2 Trends In the Prevalencementioning

confidence: 99%

Trends, Associations, and Impact of Atrial Fibrillation in Patients With Light-chain Cardiac Amyloidosis

Abe

Olanipekun

Khoury

et al. 2021

Background: In this study, we investigated the temporal trends in the prevalence and prognostic implication of atrial fibrillation (AF) in patient with light-chain cardiac amyloidosis (AL-CA). Methods: We identified 3030 patients with AL-CA from the 2015 to 2017 National Inpatient Sample, of which 1577 (52%) had AF. We used trend analysis to assess the temporal trends in the prevalence of AF by subtype from 2015 to 2017. We compared inhospital mortality, acute on chronic heart failure, stroke, length of stay (LOS), and total cost in patients with to those without AF, stratified by subtype of AF. Results: The prevalence of AF among patients with AL-CA was unchanged from 2015 to 2017 (50%-53%; adjusted odds ratio, 1.1 [0.9-1.5]; P = 0.3). The trend was unchanged in the stratified analysis by subtype of AF. Patients with AF were older and had more comorbidities. After propensity matching, acute on chronic heart failure was significantly higher in patients with AL-CA and AF, compared with those with AL-CA alone (55.6% vs. 48.3%; P < 0.0001). There was no difference in inhospital mortality (7.5% vs. 7.5%; P = 0.9), stroke (2.0% vs. 2.5%; P = 0.5), median ;