The Incidence Of Atrial Fibrillation And Influence Factors After Implantation Of Dual-chamber Pacemakers

Objective:To investigate the incidence of overt and silent atrial fibrillation(AF)and the influence factors in patients with sick sinus syndrome(SSS)or atrioventricular block(AVB)after implantation of dual-chamber pacemakers.Methods:From December 2013 to 2016 in department of Cardiology,the first hospital of Jilin university,a total of 515 cases of SSS(221)and AVB(294)without documented AF were enrolled in our study,with dual-chamber pacemaker implanted for the first time.Each patient was followed up at 1 month,3months,half a year and 1 year after the operation,and once half a year since the second year of implantation.The diagnostic data was retrieved from the implanted pacemaker,obtaining the percentage of atrial pacing(AP%)and ventricular pacing(VP%),the initiation date,seizure frequency and duration of the atrial high rate events(AHRE),whether there is atrial fibrillation happened and recorded by electrocardiogram,and symptoms of AF.The definition of atrial fibrillation: the occurrence of AF was confirmed by review of the stored intra-cardiac electrograms or AHRE>5 minutes.The silent AF was defined as the patients without palpitations,chest pain,shortness of breath,dizziness,discomfortable and stroke during AF episode.The patients were divided into two groups based on indication for implanting pacemaker,episodes and the symptoms of AF,respectively,to compare the incidence and the influence factors of overt and silent AF.Deal with SPSS 23.0 statistical software,continuous data,conformed to normal distribution,was described as the mean ± standard deviation and compared demographics by T test or variance analysis between the two groups.If not,was described as median and quartile and compared by rank sum test.Discrete data was described as the ratio or constituent ratio and compared by X2 test between groups.The correlation between basic data,clinical history,pacing data and AF was compared by multiple-factor stepwise Logistic regression analysis.P?0.05 was considered statistically significant.Results:a total of 209 cases(40.58%)were detected for more than 5min AHRE or recorded intracardiac electrograms during the follow-up.Compared to non-AF group,the AF group was associated with coronary heart disease,stroke and mitral regurgitation.The incidence of silent AF was 25%.Multivariate logistic regression analysis showed advanced age(OR1.151;CI1.121 ~ 1.183;P < 0.05),high AP%(OR1.011;CI1.003 ~ 1.019;P=0.007),history of amiodarone(OR10.006;CI3.217~31.127;P<0.05)were risk factors of AF.In addition,advanced age(OR0.957;CI0.925~0.990;P=0.011),high VP%(OR0.982;CI0.972~0.992;P<0.05)were risk factors of silent AF.Conclusion:1.For the monitoring of AF,the conventional method maybe not reliable.The actual incidence of AF and silent AF may be higher than the conventional detection rate.The continuous monitor of pacemaker is able to detect the AF episodes that difficult to detect by conventional methods,especially silent AF episodes.2.the advanced age,coronary heart disease,stroke,mitral regurgitation,left atrial enlargement and high AP% were associated with the incidence of postoperative AF.Advanced age and high AP% were the risk factors of AF.The advanced age,coronary heart disease,stroke,mitral regurgitation and high VP% were associated with the incidence of postoperative silent AF.Advanced age and high VP% were the risk factors of silent AF.