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

Wu, Yeshun; Xu, Haitao; Tu, Xiaoming; Gao, Zhiqiang

doi:10.17219/acem/157239

Cited by 4 publications

(8 citation statements)

References 131 publications

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“…The exogenous stimulation from the pacemaker implantation induce an inflammatory response, which could lead to the increased release of inflammatory mediators such as interleukin-6 (IL-6), tumor necrosis factor-alpha, and C-reactive protein, thereby downregulating the expression of cellular junction proteins and promoting abnormity in cardiac electrical conductivity. The rest of mechanisms also include autonomic nervous disorder (like sympathetic activation), etc ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of ACEI/ARB or CCB use on atrial fibrillation in hypertensive patients following permanent pacemaker implantation

Liu

Bian

et al. 2023

Front. Cardiovasc. Med.

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AimsPermanent pacemaker implantation (PPI) combined with hypertension leads to a higher risk of new-onset atrial fibrillation (NOAF) for patients. Hence, it is essential to study how to reduce this risk. Currently, the effects of the two common anti-hypertensive drugs, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and calcium channel blockers (CCB), on the risk of NOAF for such patients remain unknown. This study aimed to investigate this association.MethodsThis single-center retrospective study included hypertensive patients with PPI and without prior history of AF/atrial flutter, heart valve disease, hyperthyroidism, etc. Patients were classified into ACEI/ARB group and CCB group based on their exposure drug information. The primary outcome was NOAF events that occurred within 12 months after PPI. The secondary efficacy assessments were the changes from baseline to follow-up in blood pressure and transthoracic echocardiography (TTE) parameters. A multivariate logistic regression model was used to verify our aim.ResultsA total of 69 patients were finally included (51 on ACEI/ARB and 18 on CCB). Both univariate analysis [odds ratio (OR) 0.241, 95% confidence interval (CI) 0.078–0.745] and multivariate analysis (OR: 0.246, 95% CI: 0.077–0.792) demonstrated that ACEI/ARB were associated with a lower risk of NOAF compared to CCB. The mean reduction in left atrial diameter (LAD) from baseline was greater in ACEI/ARB group than in CCB group (P = 0.034). There was no statistical difference between groups in blood pressure and other TTE parameters after treatment.ConclusionFor patients with PPI combined with hypertension, ACEI/ARB may be superior to CCB in selecting anti-hypertensive drugs, as ACEI/ARB further reduces the risk of NOAF. One reason for this may be that ACEI/ARB improves left atrial remodelling such as LAD better.

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Section: Discussionmentioning

confidence: 99%

Effects of ACEI/ARB or CCB use on atrial fibrillation in hypertensive patients following permanent pacemaker implantation

Liu

Bian

et al. 2023

Front. Cardiovasc. Med.

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“…Due to electrophysiologic and hemodynamic alterations as well as atrial and ventricular desynchrony pacing itself provides promoting conditions that may trigger and precipitate AF. Mechanisms for pacemaker-associated AF include cardiac electrical and structural remodeling, inflammation, and autonomic nervous disorder ( 6 ).…”

Section: Pathophysiology and Mechanisms Of Pacemaker-induced Atrial F...mentioning

confidence: 99%

Section: Pathophysiology and Mechanisms Of Pacemaker-induced Atrial F...mentioning

confidence: 99%

“…One of the most important mechanisms contributing to atrial fibrillation after pacemaker implantation is electromechanical remodeling of the atria ( 6 ). Chronic pacing, particularly in the right ventricle, can lead to asynchronous contraction patterns that can result in abnormal changes in ion channel function and electrical coupling between cardiac myocytes ( 6 ). Constant pacing alters normal electrical excitation propagation and causes regions of delayed or early activation, which may favor the development of reentrant circuits and thus the development and maintenance of AF ( 6 ).…”

Section: Pathophysiology and Mechanisms Of Pacemaker-induced Atrial F...mentioning

confidence: 99%

“…Chronic pacing, particularly in the right ventricle, can lead to asynchronous contraction patterns that can result in abnormal changes in ion channel function and electrical coupling between cardiac myocytes ( 6 ). Constant pacing alters normal electrical excitation propagation and causes regions of delayed or early activation, which may favor the development of reentrant circuits and thus the development and maintenance of AF ( 6 ). In addition, the implantation process can cause local inflammation and subsequent fibrosis in the atrial tissue ( 7 ).…”

Section: Pathophysiology and Mechanisms Of Pacemaker-induced Atrial F...mentioning

confidence: 99%

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Pacemaker-induced atrial fibrillation reconsidered—associations with different pacing sites and prevention approaches

Kreimer,

Gotzmann

2024

Front. Cardiovasc. Med.

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The incidence of atrial fibrillation (AF) is significantly higher in patients with pacemakers than in the general population, which could be due to patient characteristics and the diagnostic tool of the pacemaker in detecting atrial high-rate episodes and subclinical AF, but also to the pacemaker itself providing AF-promoting conditions. It is well known that high ventricular pacemaker burden increases the likelihood of AF occurrence. However, the sites of atrial and ventricular pacing may also influence the risk for AF. The conventional sites for atrial and ventricular pacing are in the right atrial appendage and in the right ventricular apex. However, growing evidence suggests that alternative pacing sites may be superior for the prevention of AF. Bachmann bundle pacing, for example, promotes interatrial excitation conduction, resulting in atrial synchronicity and a shorter total atrial activation time, which may be preventive for the occurrence of AF. Moreover, in recent years, new ventricular pacing sites have come into focus with His bundle and left bundle branch pacing. In addition to the hemodynamic and electrophysiological cardiac benefits, these new options may also offer benefits in the prevention of AF. This review provides an overview of pacing-induced AF mechanisms and the association with different pacing sites, as well as approaches for prevention of pacing-induced AF, highlighting different sites and modes of atrial pacing and the newer sites of ventricular pacing.

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Incidence and Clinical Predictors of Atrial Fibrillation in Patients with Dual-Chamber Pacemakers: A Retrospective Analysis

Ungureanu,

Negroiu,

Docea

et al. 2024

Internal Medicine

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Atrial fibrillation (AF) is a prevalent cardiac arrhythmia, affecting millions worldwide and increasing in frequency with age. Despite progress in treatment and prevention, AF remains a significant contributor to stroke, heart failure, and overall cardiovascular morbidity. One particularly challenging type of AF, paroxysmal atrial fibrillation (PAF), is often asymptomatic, leading to delayed diagnosis and increasing the risk of severe complications like stroke. The advent of cardiac implantable electronic devices (CIEDs) has significantly improved the ability to detect subclinical AF or atrial high-rate episodes (AHRE), even in patients with no symptoms. These devices, particularly pacemakers, offer long-term, continuous monitoring of atrial rhythms, making them an invaluable tool for diagnosing AF early and assessing its burden in real time. This study focused on a cohort of patients from the Oltenia region who received dual-chamber pacemakers with no prior diagnosis of AF. The research aimed to monitor the incidence of AF in these patients over a follow-up period of 12 to 18 months and to identify potential clinical predictors for developing AF. A total of 91 patients were assessed in this study, all of whom received dual-chamber pacemakers by the pacing guidelines for conditions such as atrioventricular block and sick sinus syndrome. None of the patients had a history of AF at the time of implantation. Follow-up results indicated an incidence of AHRE in 13.19% of patients, with significant predictors including advanced age and the presence of hypertension. These findings align with the broader literature, which consistently associates both factors with an increased risk of AF. The study underscores the importance of continuous monitoring in pacemaker patients, particularly for detecting asymptomatic AF, which may necessitate specific therapeutic interventions. Although the study’s sample size was limited, its findings contribute valuable insights into managing AF in pacemaker patients, particularly regarding early detection and potential risk factors. Future research with larger cohorts is necessary to confirm and expand these results.

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

Cited by 4 publications

References 131 publications

Effects of ACEI/ARB or CCB use on atrial fibrillation in hypertensive patients following permanent pacemaker implantation

Effects of ACEI/ARB or CCB use on atrial fibrillation in hypertensive patients following permanent pacemaker implantation

Pacemaker-induced atrial fibrillation reconsidered—associations with different pacing sites and prevention approaches

Incidence and Clinical Predictors of Atrial Fibrillation in Patients with Dual-Chamber Pacemakers: A Retrospective Analysis

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