| Background and PurposeAtrial Fibrillation(AF)is the most common type of arrhythmia,and is a risk factor for cardiovascular disease,heart failure,myocardial infarction,dementia,and chronic kidney disease.A large number of studies have shown that the incidence of AF is underestimated,and many patients with paroxysmal AF are missed because they are asymptomatic.Currently,electrocardiogram and dynamic electrocardiogram are common clinical tools for detecting AF.In addition,the Cardiac Implantable Electronic Device(CIED)also has the ability to detect AF.Atrial high rate episodes(AHREs)detected by CIED have been shown to be closely associated with the occurrence of AF and thromboembolism.Therefore,the purpose of this study was to conduct a retrospective cohort analysis of patients receiving the first implantation of Dual Chamber pacemaker(DDDR),to study the incidence of AHRE and its influencing factors after implantation of DDD(R)pacemaker,and to analyze its possible mechanism and clinical significance.MethodsPatients who were diagnosed with height,third-degree Atrioventricular Block(AVB)or Sick Sinus Syndrome(Sick Sinus Syndrome)in Union Hospital Affiliated to Fujian Medical University from April 2016 to April 2020 were included.SSS)and DDD(R)pacemaker implantation for the first time in 289 patients.Patients were divided into AHRE group and NO AHRE group according to the occurrence of AHRE during follow-up.In terms of gender,age,Body Mass Index(BMI),the cause of pacemaker implantation(AVB/SSS),Hypertension(HTN)and Diabetes Mellitus,the two groups were collected and compared.DM),Coronary Heart Disease(CHD),history of stroke,history of vascular Disease,drug use after implantation,Atrial Pacing Proportion,(AP%),Ventricular Pacing Proportion(Vp %),Cha2DS2-VASC score,NYHA grade,end point events,echocardiographic parameters and other indicators.Multivariate Logistic regression analysis,multivariate Cox regression analysis and ROC curve were used to study the influencing factors of AHRE.According to the etiology of pacemaker implantation,the patients were divided into SSS group and AVB group.The survival difference between SSS group and AVB group was studied by Kaplan-Meier curve.Results1 A total of 289 patients with DDD(R)pacemakers were included,and 91 patients with AHRE were detected,accounting for 31.5%.2 were divided into AHRE group(n=91,mean age 71.9±9.2 years)and NO AHRE group(n=198,mean age 66.3±11.7 years).There were statistically significant differences between the two groups in age,cause of pacemaker implantation,AP%,use of β-blockers and antiarrhythmic drugs after implantation,endpoint events,left atrial diameter,left ventricular posterior wall thickness and left ventricular mass index(P <0.05).3 Independent risk factors for AHRE were age(OR=1.060,95%CI: 1.027-1.093,P=0.000),beta blockers(OR=2.520,95%CI: 1.275-4.981,P=0.008),pathological sinus node syndrome(OR=4.550,95%CI :1.634-12.669,P=0.004),atrial pacing ratio(OR=1.018,95%CI: 1.077-1.029,P=0.001).4 The independent predictors of the occurrence of AHRE were age(OR=1.041,95%CI :1.018-1.065,P=0.000)and pathological sinus node syndrome(OR=2.224,95%CI: 1.226-4.035,P=0.009),atrial pacing ratio(OR=1.009,95%CI: 0.986-2.440,P=0.017).5 The optimal diagnostic cutoff for age 5 was 65 years.The optimal diagnostic cutoff value of atrial pacing ratio was 53.5%.6 Compared with preoperative diagnosis of atrioventricular block,patients with pathological sinus syndrome had a higher incidence of AHRE and the onset of AHRE was earlier(P=0.000).Conclusion1 A total of 289 patients with DDD(R)pacemaker implantation were included,accounting for 31.5% of AHRE.2 The independent risk factors and independent predictors of AHRE were age,pathological sinus syndrome,and atrial pacing ratio.3.Patients with age ≥65 years old,atrial pacing ratio ≥53.5%,and pathological sinus node syndrome had a significantly higher incidence of newly diagnosed AHRE.Therefore,follow-up should be strengthened in order to detect AHRE early... |
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