Analysis Of Risk Factors Associated With New-onset Atrial Fibrillation After Cardiac Dual-chamber Pacemaker Implantation

Objective:To investigate the risk factors for new-onset postoperative AF in patients without a history of atrial fibrillation（AF）who underwent cardiac dual-chamber pacemaker implantation.Then analyzing the predictive ability of independent risk factors and their combined models for new-onset AF after pacemaker implantation.Methods:Data were collected from 223 patients who were admitted to the Su Bei People’s Hospital Cardiology Department for the first time for cardiac dual-chamber pacemaker implantation from January 1,2019 to March 31,2021.The data includes preoperative baseline data and follow-up-related data.The 223 patients were divided into new-onset AF group and no-AF group according to whether AF occurred.The differences in baseline data and pacemaker-related parameters were analyzed,and independent risk factors were screened by dichotomous logistic regression for statistically significant indicators.The receiver operating characteristic（ROC）curves were used to assess the predictive ability of the independent risk factors and their combined prediction models for new-onset AF after pacemaker implantation.Results:1.At a mean follow-up of 17.94±9.05 months after the procedure,45（20%）new-onset AF occurred after pacemaker implantation,namely 21（47%）symptomatic AF,10（22%）subclinical atrial fibrillation（SCAF）,atrial high rate event（AHRE）in 14 cases（31%）.In the new-onset AF group and the no AF group,there was statistically significant difference in history of diabetes mellitus,history of alcohol consumption,uric acid,left atrial diameter（LAD）,left ventricular ejection fraction,percentage of atrial contraction（PAC%）,mean heart rate and fastest heart rate(HR_Max),and ventricular pacing percentage（VP%）,pacing modes,andβ-blockers（P<0.05）.2.Gender,age,body mass index and the above risk factors were included and multifactorial dichotomous logistic regression was used to show that gender（OR=0.170,95%CI（0.050,0.573）,P=0.004）,history of alcohol consumption（OR=9.319,95%CI（2.688,32.304）,P<0.001）,LAD（OR=1.143,95%CI（1.024,1.276）,P=0.018）,VP%（OR=1.045,95%CI（1.023,1.067）,P<0.001）、HR_Max（OR=1.044,95%CI（1.021,1.067）,P<0.001）、PAC%（OR=2.001,95%CI（1.427,2.807）,P<0.001）were independent risk factors for new onset AF after pacemaker implantation.3.One-way ROC curve analysis showed that the area under the curve（AUC）for gender,history of alcohol consumption,LAD,VP%,HR_Max,and PAC%to predict the occurrence of AF in patients after pacemaker implantation were 0.433,0.588,0.681,0.771,0.648,and 0.877,respectively.4.The combined independent risk factor model predicted the occurrence of new onset AF in patients after pacemaker implantation with an AUC of 0.928 and a cut-off value of 0.249,with a sensitivity of 86.7%and a specificity of 86.0%at this point.Conclusion:1.Female,history of alcohol consumption,larger LAD,faster HR_Max,increased VP%and PAC%are independent risk factors for new-onset AF after pacemaker implantation.2.Combining gender,history of alcohol consumption,LAD,VP%,HR_Max,PAC%indicators is expected to be a powerful tool for screening patients at high risk of new-onset AF after pacemaker implantation.