Predictors of Newly Detected Atrial Fibrillation following Dual-Chamber Permanent Pacemaker

Background and aim: Silent atrial fibrillation (AF) detection with stored EGMs (SAFE) registry may identify patients at increased risk for stroke and death. This study evaluated the clinical predictors of newly detected atrial fibrillation in patients following dual-chamber permanent pacemaker (PPM) implantation and time course of AF incidence and development in a general pacemaker population with AF or without AF. Methods: We evaluated 318 patients without documented AF who received dual-chamber PPMs with features that permit detection and storage of information about the date, time of onset, and duration of multiple, sequential episodes of AF. Patients were followed up for one month, six months, and one year. All demographic and clinical data were determined and assessed following PPM implantation. Results: Totally, 318 patients with dual-chamber PPMs were enrolled. New incidence of AF was 18.9%. Of these patients, new AF occurrence during a one-month period after PPM implantation was 4.5%, after 6 months was 22.7%, and after one year of follow-up was 82.1%. Also, 57.8% of the new cases of AF experienced several atrial high rate episodes. Greater than 90% cumulative ventricular pacing was a significant predictor - with a risk of 1.6 in the occurrence of AF. Other factors influencing the incidence of AF after the implantation of dualchamber pulse generators were heart failure, underling sinus node disorder, left ventricular dysfunction, P wave shape showing left atrial enlargement, and severity of ventricular disease. Conclusion: AF episodes develop significantly after dual-chamber PPM implantation in a great number of patients. In this study, the effect of the underlying disease of sinus node, P wave form in the ECG, left ventricular dysfunction, valvular disease, and greater than 90% cumulative right ventricular pacing were determined as factors influencing the incidence of AF after dual-chamber PPM implantation. Also, the risk of AF incidence after one year in our patients with dual-chamber PPMs had an increase. Therefore, we would suggest that the cumulative percentage of ventricular pacing be decreased with a new method to prevent AF incidence.