title: Clinical, Echocardiographic, and Electrocardiographic Predictors of Persistent Atrial Fibrillation after Dual-Chamber Pacemaker Implantation: An Integrated Scoring Model Approach.
abstract: Persistent atrial fibrillation (PeAF) predictors after dual-chamber pacemaker (PM) implantation remain unclear. We sought to determine these predictors and establish an integrated scoring model. Data were retrospectively reviewed for 649 patients (63.8 ± 12.3 years, 48.6% male, mean CHA2DS2-VASC score 2.7 ± 2.0) undergoing dual-chamber PM implantation. PeAF was defined as documented AF on two consecutive electrocardiograms acquired ≥7 days apart. During a 7.1-year median follow-up (interquartile range 4.5-10.1 years), 67 (10.3%) patients had PeAF. Multivariable analysis showed the following independent predictors of future PeAF: ischemic stroke or transient ischemic accident history (hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.03-3.50, p = 0.040), atrial fibrillation/flutter history (HR 1.80, 95% CI 1.01-3.20, p = 0.046), sinus node disease (HR 2.24, 95% CI 1.16-4.35, p = 0.016), left atrial enlargement (>45 mm, HR 2.14, 95% CI 1.26-3.63, p = 0.005), and time in automatic mode switching >1% at first follow-up interrogation (HR 2.58, 95% CI 1.51-4.42, p < 0.001). An integrated scoring model combining these predictors showed good discrimination performance at the seven-year follow-up. (C-statistic 0.716, 95% CI 0.629-0.802, p < 0.001). Significantly greater seven-year PeAF incidences were seen in patients with higher scores (2-5) than in those with lower scores (0-1) (22.8% ± 3.8% vs. 5.3% ± 1.7%, p < 0.001). In conclusion, an integrated scoring model combining clinical, echocardiographic, and electrocardiographic characteristics is useful for predicting future PeAF in patients with a dual-chamber PM.
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Cho
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jun
authors.identifier: http://orcid.org/0000-0002-3573-638X
authors.initials: J
authors.lastname: Kim
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Ju Hyeon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Minsu
authors.initials: M
authors.lastname: Kim
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: You Mi
authors.initials: YM
authors.lastname: Hwang
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Uk
authors.initials: U
authors.lastname: Jo
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Gi-Byoung
authors.initials: GB
authors.lastname: Nam
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Kee-Joon
authors.initials: KJ
authors.lastname: Choi
authors.affiliation: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: You-Ho
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D010138:Pacemaker, Artificial; D019736:Prostheses and Implants; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications; D013997:Time Factors