Establishment And Verification Of A Nomogram For Predicting The Probability Of New-onset Atrial Fibrillation After Dual-chamber Pacemaker Implantation

Objective: The purpose of this study was to establish and validate a minimalistic nomogram as a predictive model in patients with new-onset atrial fibrillation(AF)after dual-chamber pacemaker implantation.Methods: All patients who underwent surgeries of cardiac implantable electronic devices from January 2017 to December 2018 in Sir Run Run Shaw Hospital were included in this retrospective study.Clinical features,laboratory results,and radiological data were analyzed.Based on whether new-onset AF was identified after pacemaker implantation,all patients were divided into two groups.51 patients were assigned to the new-onset AF group(new-onset AF after pacemaker implantation),and 225 patients were assigned to the non-AF group.Least absolute shrinkage and selection operator(LASSO)method was used to determine the best predictors.Through multivariate logistic regression analysis,we draw a nomograms as a predictive model.C-index,calibration plot,and decision curve analysis were applied to evaluate the discrimination,calibration,and clinical applicability of the predictive model.Internal verification was performed by bootstrap method.Results: LASSO regression analysis found that variables including peripheral arterial disease(PAD),atrial pacing-ventricular pacing(AP-VP)≥50%,atrial senseventricular sense(AS-VS)≥50%,increased left atrium diameter(LAD)and advanced age were important predictors of developing AF after dual-chamber pacemaker implantation.Combined with the clinical significance and the comprehensive analysis of LASSO regression results,the four variables obtained from LASSO including: PAD,AP-VP≥50%,increased LAD and age were taken into the logistic regression model and the nomogram the was established.In multivariate logistic regression,PAD(OR=1.812,95% CI 0.917-3.585,p<0.001),AP-VP≥50%(OR=3.006,95%CI 1.242-7.279,p<0.015)and age(OR=1.037,95% CI 1.004-1.072,p=0.029)were found to be independent predictors of new-onset AF.The nomogram predictive model of this study has good discrimination,calibration and clinical application value.The C-index is 0.726(95% CI:0.717–0.735),and the internally verified C-index is 0.727(95% CI:0.651-0.800).Calibration curve showed good consistency between the predictions of the nomogram and the actual observations.The decision curve analysis(DCA)shows that the nomograms established in this study has value for clinical application.Conclusion: 51(18.5%)of patients developed new episode of AF after dualchamber pacemaker implantation during an average follow-up period of 23.44±7.31 months.The nomogram,incorporating PAD,AP-VP ≥50%,age and increased LAD,was an individualized,predictive model of clinical significance,which may help physicians identify patients at high risk of new-onset AF after pacemaker implantation at an early stage.