Study On Predictors Of Atrial High Rate Episode In Patients After Dual Chamber Pacemaker Surgery

Objective:Relevant studies abroad have confirmed that atrial high rate episode(AHRE)are closely related to the occurrence of stroke.Previous studies have found that the incidence of AHRE in patients with implanted dual chamber permanent pacemakers(PPM)is high,and there is currently no consensus on the risk factors and predictive factors for AHRE in such patients,This study aims to explore this point and provide some clinical evidence for screening high-risk patients with AHRE after dual chamber pacemaker implantation in clinical work.Methods:From January 2021 to March 2022,216 patients with no previous history of atrial fibrillation(AF)or atrial flutter(AFL)who were implanted with dual chamber permanent pacemakers due to atrioventricular block(AVB)or sick sinus syndrome(SSS)in the Department of Cardiology of our hospital were retrospectively analyzed,This study defines AHRE according to the 2020 European Heart Association Guidelines for Atrial Fibrillation: Atrial events with an atrial frequency of ≥ 175 beats per minute and a duration of ≥ 5 minutes,or episodes of AF/AFL recorded by cardiac pacemakers.Baseline data,electrocardiogram,cardiac echocardiography data,ventricular electrode implantation location,and clinical data such as AHRE events detected by pacemakers at 1 month,3 months,6 months,and 1 year after pacemaker implantation,as well as atrial frequency at onset,duration,percentage of atrial pacing,and medication history were collected,According to whether the pacemaker detected the occurrence of AHRE during the follow-up period,patients were divided into two groups: the study group(AHRE+,n=64)and the control group(AHRE-,n=152).Statistical analysis was conducted on data such as gender,age,underlying disease,P-wave dispersion,echocardiographic related data,percentage of atrial pacing(AP%),ventricular electrode implantation location,and postoperative medication history between the two groups,To investigate the incidence,risk factors,and predictors of AHRE in patients with dual chamber pacemaker implantation.Results:The average follow-up was 12 ± 0.8 months.Univariate analysis showed that age,atrial pacing ratio,left atrial diameter,right atrial diameter,diabetes,congestive heart failure,and P wave dispersion(PWD)were risk factors for AHRE,Multivariate logistic regression analysis showed that atrial pacing ratio and left atrial diameter of pacemakers were independent risk factors for AHRE;ROC regression curve analysis showed that both left atrial diameter and atrial pacing ratio had good predictive efficacy for AHRE,and the predictive efficacy of left atrial diameter was better than that of atrial pacing ratio.The optimal cutoff value for left atrial diameter is 36.5 mm(area under curve: 0.865,sensitivity: 70.13%,specificity: 90.13%),and the optimal cutoff value for AP% is 33.75%(area under curve: 0.805,sensitivity: 71.88%,specificity: 87.5%).Conclusion:Left atrial diameter and atrial pacing ratio are predictors of atrial high rate episode in patients without a previous history of atrial fibrillation and undergoing dual chamber pacemaker implantation due to sick sinus syndrome(SSS)or atrioventricular block(AVB).