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Determinants of persistent atrial fibrillation in patients with DDD pacemaker implantation
Ahmet Duran Demir1, Mustafa Soylu, Ozcan Ozdemir
1Department of Cardiology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. demirad@ixir.com
Insights
Persistent atrial fibrillation (AF) in pacemaker patients is linked to prior AF episodes, larger left atrial size, and specific ECG markers like prolonged P wave duration and P wave dispersion. Early identification of these factors aids in preventing persistent AF.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrial fibrillation (AF) in patients with dual-chamber (DDD) pacemakers contributes significantly to morbidity and mortality.
- Identifying predictors of persistent AF is crucial for improving patient outcomes and guiding treatment strategies.
Purpose of the Study:
- To prospectively identify clinical, echocardiographic, and electrocardiographic determinants of persistent AF in patients with DDD pacemakers.
- To establish predictive values for key electrocardiographic markers in identifying patients at risk for persistent AF.
Main Methods:
- Prospective follow-up of 101 consecutive patients with DDD pacemakers for an average of 19.8 months.
- Clinical data, echocardiographic measurements (left atrial dimension), and 12-lead surface electrocardiograms (P wave duration and P wave dispersion) were analyzed.
- Cox regression analysis was used to determine risk factors for persistent AF.
Main Results:
- Persistent AF occurred in 20.8% of patients.
- Predictors of persistent AF included previous AF attacks (RR 8.95), increased left atrial dimension (RR 2.1), P wave maximum duration ≥ 120 ms (RR 6.1), and P wave dispersion (PWD) ≥ 40 ms (RR 12.2).
- P wave dispersion demonstrated high sensitivity (85.7%) and specificity (87.5%) for predicting persistent AF.
Conclusions:
- Previous AF history, increased left atrial size, prolonged P wave duration, and P wave dispersion are significant risk factors for persistent AF in DDD pacemaker patients.
- These findings highlight the need for intensified management strategies in high-risk patients to prevent persistent AF development.
Abstract:
Occurrence of AF in a pacemaker implanted patient is a significant cause of morbidity and mortality. The aim of this study was to prospectively investigate the clinical, echocardiographic, and electrocardiographic determinants of persistent AF in patients with DDD pacemakers. A 101 consecutive patients were followed for an average of 19.8 +/- 11.8 months. Persistent AF was documented in 21 (20.8%) patients and 80 (79.2%) patients were in sinus or physiologically paced rhythm. In patients with persistent AF, previous AF attacks were observed more frequently (P < 0.03) and left atrial dimension was higher (3.5 +/- 0.6 vs 3.0 +/- 0.5 cm, P < 0.001). Average P maximum and P wave dispersion (PWD) values calculated in a 12-lead surface electrocardiogram were also found to be significantly higher in patients with persistent AF (P < 0.001). Cox regression analysis demonstrated that the presence of previous AF attacks (RR 8.95, P < 0.001), increased left atrial dimension (RR 2.1, P < 0.02), P maximum duration 120 ms (RR 6.1, P < 0.001), and PWD 40 ms (RR 12.2, P < 0.001) were associated with an increased risk of persistent AF. Cut-off points were 120 ms for P maximum and 40 ms for PWD. Sensitivity, specificity, and positive and negative predictive values were calculated as 76.2, 82.5, 53.3, and 92.9 for P maximum and as 85.7, 87.5, 64.3, and 95.9 for PWD, respectively. In patients with DDD pacemakers, previous AF attacks, increased left atrial dimension, P maximum value of 120 ms, and a PWD value of 40 ms were associated with a significantly increased risk of persistent AF. These patients must further be managed with other treatment modalities to prevent the development of persistent AF.