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Predictors and Clinical Impact of Atrial Fibrillation After Pacemaker Implantation in Elderly Patients Treated with Dual Chamber Versus Ventricular Pacing
Author(s) -
STAMBLER BRUCE S.,
ELLENBOGEN KENNETH A.,
ORAV E. JOHN,
SGARBOSSA ELENA B.,
MARK ESTES N. A.,
RIZOPATRON CARLOS,
KIRCHHOFFER JAMES B.,
HADJIS TOM A.,
GOLDMAN LEE,
LAMAS GERVASIO A.
Publication year - 2003
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2003.00309.x
Subject(s) - medicine , atrial fibrillation , cardiology , artificial cardiac pacemaker , randomization , sick sinus syndrome , bradycardia , heart failure , proportional hazards model , prospective cohort study , randomized controlled trial , heart rate , blood pressure
The Pacemaker Selection in the Elderly (PASE) trial was a prospective, multicenter, single blind, randomized comparison of single chamber, rate adaptive, ventricular pacing (VVIR) with dual chamber, rate adaptive pacing (DDDR) in 407 patients aged ≥65 years(mean 76 ± 7 years, 60% male)with standard bradycardia indications for dual chamber pacemaker implantation. The incidence, predictors, and clinical consequences of atrial fibrillation (AF) developing after pacemaker implantation in the PASE trial were studied prospectively. During a median follow‐up of 18 months, AF developed in 73 (18%) patients. Kaplan‐Meier estimated cumulative incidences of AF in patients with sinus node dysfunction (n = 176) at 18 months were 28% in the VVIR and 16% in the DDDR groups (P = 0.08). After adjustment for other clinical variables using a Cox multivariate regression model, randomization to VVIR compared with DDDR pacing mode among patients with sinus node dysfunction was independently associated with a 2.6‐fold increased relative risk (RR) of developing AF after pacemaker implantation (P = 0.01). Other independent clinical risk factors for development of postimplant AF included a preimplant history of hypertension (P = 0.02) or supraventricular tachyarrhythmias(P < 0.04) . Patients who developed AF had similar health related quality of life scores and cardiovascular functional status after 18 months of pacing as patients who remained free of AF. The RR of death, stroke, or heart failure hospitalization was not increased in patients who developed AF. Thus, in the elderly patients with sinus node dysfunction requiring permanent pacing, DDDR pacing mode protected against the development of AF. However, development of AF after pacemaker implantation in this population was not associated with a significant impact on quality‐of‐life, functional status, or other clinical endpoints during 18 months of follow‐up. (PACE 2003; 26:2000–2007)