title: Persistent atrial fibrillation is associated with a poor prognosis in patients with atrioventricular block and dual-chamber pacemaker.
abstract: BACKGROUND
  The prognostic significance of development of persistent atrial fibrillation (AF) in patients with atrioventricular (AV) block and dual chamber (DDD) pacemakers has not been separately investigated. We sought to determine whether persistent AF influences clinical outcome in these patients.
  
  
  METHODS
  Three hundred-eight consecutive patients with second- or third-degree AV block and implanted a DDD pacemaker were followed for 36 ± 20 months and retrospectively divided into two groups. Thirty-four patients who developed persistent AF formed persistent AF group, and 278 patients who remained free of this arrhythmia control group. Clinical and outcome data of the two groups were compared. The primary outcome was cardiovascular death.
  
  
  RESULTS
  The primary outcome occurred more often among the patients in the persistent AF group (6.8% per year) than among those in the control group (2.9% per year; P = 0.028). This difference was primarily because of higher rate of heart failure-related deaths in the persistent AF group (P = 0.009). Secondary outcomes, hospitalization for heart failure and paroxysmal AF episode ≥5 minutes, occurred also more often among the patients in the persistent AF group (P = 0.008 and P < 0.001, respectively), although the risk of nonfatal stroke was similar in both groups (P = 0.628).
  
  
  CONCLUSIONS
  In patients with second- or third-degree AV block and DDD pacemaker, the development of persistent AF is associated with an increased risk of cardiovascular death and heart failure.
authors.affiliation: Bogdan Cardiology Polyclinic, Zagreb, Croatia. d.petrac@inet-hr
authors.forename: Dubravko
authors.initials: D
authors.lastname: Petrač
authors.forename: Vjekoslav
authors.initials: V
authors.lastname: Radeljić
authors.forename: Diana
authors.initials: D
authors.lastname: Delić-Brkljačić
authors.forename: Šime
authors.initials: Š
authors.lastname: Manola
authors.forename: Greta
authors.initials: G
authors.lastname: Cindrić-Bogdan
authors.forename: Nikola
authors.initials: N
authors.lastname: Pavlović
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality* / Q000517:prevention & control*; D054537:Atrioventricular Block / Q000401:mortality* / Q000517:prevention & control*; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data*; D002908:Chronic Disease; D015897:Comorbidity; D017523:Croatia / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome