PERMANENT ATRIAL FIBRILLATION DEVELOPMENT IN LONG-TERM FOLLOW-UP OF DDD PATIENTS: THE INCIDENCE AND PREDISPOSING FACTORS

M. Debski, M. Ulman, A. Zabek, K. Haberka, J. Lelakowski, B. Malecka

Department of Electrocardiology, John Paul II Hospital in Krakow, Krakow, Poland

Abstract

Introduction: We aimed to determine the incidence of AF development in DDD patients population with long-term follow-up and to identify the predisposing factors.
Methods: A group of 995 consecutive patients with DDD pacemaker implanted between 1984 and 2002 were followed up until 2014. Follow-up period was 124.2 68.3 months, mean age at implantation 63.5 12.4 years, 56% male, 77% had SSS, 48% had AVB, 26% had prior paroxysmal AF. The end-point was defined as reprogramming to VVI mode due to permanent AF development.
Results: Permanent AF occurred in 207 patients (20.8%) after a mean of 74.7 52.1 months. After 1, 5, 10, 15 years DDD mode was preserved in 97.7%, 90.0%, 79.1% and 71.7%, respectively. Patients who developed permanent AF were older at implantation, had more SSS and prior paroxysmal AF compared to patients in sinus rhythm (Table 1). Multivariate analysis of risk factors is presented in Table 2.
Conclusions: The loss of physiologic pacing due to development of AF affects 21% of DDD patients. The risk factors are SSS, prior AF and implantation at older age.


Comparison of patients who developed permanent AF with those who remained in sinus rhythm.
Patients with permanent AF (N=207) Patients in sinus rhythm (N=788) P
AVB [N,%] 92 (44%) 389 (49%)0.2074
SSS [N,%] 177 (86%) 591 (75%) 0.0014
History of paroxysmal AF [N,%] 98 (47%) 156 (20%) 0.0000
Age at implantation SD [years] 67.3 9.2 156 (20%) 0.0000
Men [N,%] 105 (51%) 452 (57%) 0.0870

Multivariate analysis of clinical features which might predispose to development of permanent AF.
Parameter HR 95% CI P
Male gender 1.09 0.82 - 1.430.5616
AVB 1.28 0.93 - 1.75 0.1275
SSS 1.70 1.09 - 2.65 0.0190
history of paroxysmal AF 3.05 2.29 - 4.07 0.0000
implantation at age over 65 years old 2.24 1.67 - 3.02 0.0000