Analyses of risk factors and prognosis for new-onset atrial fibrillation in elderly patients after dual-chamber pacemaker implantation

OBJECTIVE: To retrospectively identify risk factors and the prognosis for new-onset atrial fibrillation (AF) after implantation of dual-chamber pacemakers in elderly patients. METHODS: Consecutive patients aged ≥ 65 years who underwent their first implantation of a dual-chamber permanent pacemaker in Beijing Anzhen Hospital from October 2013 to May 2016 were enrolled. Their complete programming and follow-up data were recorded. Follow-up end points included new-onset AF and major adverse cardiovascular and cerebrovascular events. RESULTS: Altogether, 322 patients were enrolled, with new-onset AF observed in 79 (24.5%) during their follow-up. Multivariable analysis identified four independent predictors of new-onset AF in elderly patients after pacemaker implantation: hypertension (HR = 3.040, 95% CI: 1.09–3.05, P = 0.00); age (HR = 1.966, 95% CI: 1.57–3.68, P = 0.01); left atrial enlargement (HR = 1.645, 95% CI: 1.05–1.25, P = 0.03); high ventricular pacing rate (HR = 1.137, 95% CI: 1.01–1.06, P = 0.01). Univariable analysis indicated that the CHA(2)DS(2)-VASc score was also a risk factor for AF (HR = 1.368, 95% CI: 1.178–1.589, P = 0.002), whereas multivariable regression analysis did not. Kaplan–Meier survival analysis showed that the risk for ischemic stroke was significantly higher in the new-onset AF group than in the non-AF group (P < 0.05). CONCLUSION: Hypertension, age, left atrial enlargement, and high ventricular pacing rate were independent predictors of new-onset AF in elderly patients after implantation of a permanent pacemaker. New-onset AF increased the risk for ischemic stroke.