| Objective To investigate the incidence of atrial fibrillation(AF), heart failure(HF) and stroke in patients with sinus rhythm after cardiac pacing therapy. The influence of atrial fibrillation on heart failure and stroke was exploredMethods 1344 patients with sinus rhythm who were implanted their first pacemakers from 2002 to 2008 in Tianjin Chest Hospital were followed for 75.7±24.5 months in our restrospective study. 1)The patient’s basic characteristics were collected including age, sex, NYHA functional class, AF and stroke history; 2) All the patients were followed every 12 months. According to their records of AF episode in follow-up, patients were divided into 3 groups(non-AF group, paroxysmal AF group, and permanent AF group). The events of HF, AF, death were also recorded during follow up. Cause of death was determined by review of hospital records and by telephone interview. Kaplan-Meier survival analysis and COX regression analysis were performed to assess the relationship between AF and heart failure as well as stroke.Results(1) After an average 75.7±24.5 months’ follow-up, 284 patients presented AF(21.1%), of whom 145 were diagnosed as persistent AF(10.8%). The history of paroxysmal AF, older than 65 years old, VVI pacing mode, sick sinus syndrome were risk factors for AF episode(P <0.05). Patients with diabetes, sick sinus syndrome, elderly patients, and VVI pacing mode and history of AF before pacemaker implantation were associated with increased risk of persistent AF(P <0.05).(2) 325 patients(24.2%) experienced heart failure, and 101 patients(7.5%) presented stroke events. The mortality was 19.6%(n=264), Cardiovascular deaths were 168 cases(12.5%). The incidence of heart failure, stroke and cardiovascular death in the AF group were higher compared with non-AF group(Kaplan-Meier survival analysis,P <0.05).(3) Compared with the non-AF group, persistent AF group was associated with higher incidence of heart failure(Log Rank: χ2=17.217, P <0.001). COX regression analysis revealed the hazard ratio(HR) is 1.27(95% CI, 1.099~1.466). Paroxysmal AF group had highest incidence of stroke compared with other two groups(Log Rank, P <0.001). Compared with non-AF group, the hazard ratios for stroke in paroxysmaland persistent AF groups were 5.65(95% CI, 3.6~8.87) and 1.777(95% CI 1.38~2.288) respectively,after adjusting age and gender.(4) Patients with SSS showed higher incidence of AF as well as stroke but lower incidence of HF than patients with AVB. The incidence of sroke was different among non-AF, paroxysmal AF, and persistent AF groups in SSS group(Log Rank: χ2= 56.621, P <0.001) as well as in AVB sub-groups(Log Rank: χ2= 7.071, P <0.05), while different incidence of HF were only presented in SSS sub-group(Log Rank: χ2= 30.611, P <0.001). In SSS group, the HR for stroke in paroxysmal AF group and persistent AF group were 5.694(95%CI 3.349~9.680) and 1.815(95%CI 1.356~2.429), compared with non-AF group. Persistent AF increased the developing of HF( HR 1.73,95%CI 1.42~2.113). In AVB group paroxysmal AF increased the episode of stroke(HR 4.304, 95% CI,1.589~11.656). Similar results were presented in DDD pacing patients.Conclusions 1) The overall incidence of atrial fibrillation in patients was high in patients with pacemaker implantation, Persistent AF had significantly higher risk of heart failure, stroke and cardiovascular death than those who remained free of AF. 2) Patients who developed persistent AF had significantly higher risk of heart failure, stroke than the the patients without AF, suggesting that the onset of persistent AF was an independent risk factor of heart failure and stroke after pacing; 3) Paroxysmal AF may increase the risk of stroke in patients with SSS and AVB. Patients with SSS who present persistent AF after cardiac pacing have a high risk of heart failure and stroke. |
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