| ObjectiveTo demonstrate the clinical characteristics of patients with new-onset atrial fibrillation after dual-chamber paceker implantation,analyse the relative risks of new-onset atrial fibrillation and reveal the anticoagulation status of patients with new-onset atrial fibrillation in real world.Methods622 patients with intact clinical material and follow-up material were collected from April 2011 to December 2016,among which 302 patients were not diagnosed with atrial fibrillation after pacemaker implantation.Clinical data like age,sex,comorbidities,heart structures and pacing proportions were also collected.We used electronical medical record system and phone call to follow up the occurence of new-onset atrial fibrillation,anticoagulation therapy and catheter ablation.Based on the occurence of new-onset atrial fibrillation,these cases were divided into atrial fibrillation group(AF Group)and non-atrial fibrillation group(non-AF Group).And patients with new-onset atrial fibrillation were further divided into anticoagulation group and non-anticoagulation group.Relative risks were analyzed between AF Group and non-AF Group,and anticoagulation status were analyzed between anticoagulation group and non-anticoagulation group.Results1.622 recipients with intact clinical material and follow-up material were collected.In these patients,256 patients were diagnosed with atrial fibrillation before pacemaker implantation,64 atrial fibrillation episodes were detected during pacemaker implantation procedure.302 patients without atrial fibrillation were enrolled in the study.During the mean follow-up period of 50.6±22.3 months,6 patients died,1 patient received pacemaker removal procedure,48 patients were diagnosed with new-onset atrial fibrillation.The overall prevalence rate of atrial fibrillation was 59.2%,incidence rate was 15.9%,and all-cause mortality was 2.0.Among the new-onset atrial fibrillation cases,21(43.8%)were symptomatic atrial fibrillation,17(35.4%)were subclinicalatrial fibrillation and 10 cases(20.8%)were atrial high rate episodes.2.Univariate analysis revealed that there existed significant differences in the application of β-blocker,decrease of LVEF,high atrial pacing proportion and high ventricular pacing proportion between AF Group and non-AF Group(P<0.05).No significant differences were found in age,sex,comorbidities(hypertension,hyperlipidemia,coronary artery disease,chronic kidney disease and stroke),other drug applications(CCB,ACEI/ARB and anti-platelet agents),other UCG parameters(left atrial diameter,mitral valve regurgitation)and pacemaker implantation indications(P>0.05).3.Multivariate logistic regression analysis revealed that age(OR=1.070;95%CI 1.044-1.097;P<0.001)and high atrial pacing proportion(OR=2.131;95%CI 1.026-4.428;P=0.042)were independent risks for new-onset atrial fibrillation.As the age went up by 1 year,the risk for atrial fibrillation increased by 7%.4.Among 48 patients with new-onset atrial fibrillation,10 patients(21.3%)received routine anticoagulation therapy,4 patients(8.3%)received catheter ablation.The CHA2DS2-VASc score in patients receiving anticoagulation therapy was significantly higher than that in patients without anticoagulation therapy(median score 5.50 VS 3.50,P=0.005).Conclusion1.The overall prevalence rate of atrial fibrillation was 59.2%,incidence rate was 15.9%,and all-cause mortality was 2.0%.2.The risks for new-onset atrial fibrillation in patients after dual-chamber pacemaker implantation included β-blocker application,decrease of LVEF,high atrial pacing proportion and high ventricular pacing proportion.3.Age and high atrial pacing proportion were independent risks for new-onset atrial fibrillation.As the age went up by 1 year,the risk for atrial fibrillation increased by 7%.4.Among patients with new-onset atrial fibrillation,21.3%of them received routine anticoagulation therapy,CHA2DS2-VASc score was useful in guiding anticoagulation therapy. |
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