Determinants of persistent atrial fibrillation in patients with DDD pacemaker implantation


DEMİR A. D., Soylu M., ÖZDEMİR Ö., Balbay Y., Topaloǧlu S., Şaşmaz A., ...More

PACE - Pacing and Clinical Electrophysiology, vol.26, no.3, pp.719-724, 2003 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 26 Issue: 3
  • Publication Date: 2003
  • Doi Number: 10.1046/j.1460-9592.2003.00122.x
  • Journal Name: PACE - Pacing and Clinical Electrophysiology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.719-724
  • Keywords: atrial fibrillation, dual chamber pacemaker, SICK SINUS SYNDROME, PACING MODE, ENDOCARDIAL ELECTROGRAMS, CONDUCTION DEFECTS, PACED PATIENTS, EXCITABILITY, MODALITIES, MORTALITY, SURVIVAL
  • Lokman Hekim University Affiliated: No

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.