TY - JOUR
T1 - Clinical, echocardiographic, and electrocardiographic predictors of persistent atrial fibrillation after dual-chamber pacemaker implantation
T2 - An integrated scoring model approach
AU - Cho, Min Soo
AU - Kim, Jun
AU - Kim, Ju Hyeon
AU - Kim, Minsu
AU - Lee, Ji Hyun
AU - Hwang, You Mi
AU - Jo, Uk
AU - Nam, Gi Byoung
AU - Choi, Kee Joon
AU - Kim, You Ho
N1 - Publisher Copyright:
© 2016 Cho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Persistent atrial fibrillation (PeAF) predictors after dual-chamber pacemaker (PM) implantation remain unclear. We sought to determine these predictors and establish an integrated scoring model. Data were retrospectively reviewed for 649 patients (63.8 ± 12.3 years, 48.6% male, mean CHA2DS2-VASC score 2.7 ± 2.0) undergoing dual-chamber PM implantation. PeAF was defined as documented AF on two consecutive electrocardiograms acquired ≥7 days apart. During a 7.1-year median follow-up (interquartile range 4.5-10.1 years), 67 (10.3%) patients had PeAF. Multivariable analysis showed the following independent predictors of future PeAF: ischemic stroke or transient ischemic accident history (hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.03-3.50, p = 0.040), atrial fibrillation/flutter history (HR 1.80, 95% CI 1.01-3.20, p = 0.046), sinus node disease (HR 2.24, 95% CI 1.16-4.35, p = 0.016), left atrial enlargement (>45 mm, HR 2.14, 95% CI 1.26-3.63, p = 0.005), and time in automatic mode switching >1% at first follow-up interrogation (HR 2.58, 95% CI 1.51-4.42, p < 0.001). An integrated scoring model combining these predictors showed good discrimination performance at the seven-year follow-up. (C-statistic 0.716, 95% CI 0.629-0.802, p < 0.001). Significantly greater seven-year PeAF incidences were seen in patients with higher scores (2-5) than in those with lower scores (0-1) (22.8% ± 3.8% vs. 5.3% ± 1.7%, p < 0.001). In conclusion, an integrated scoring model combining clinical, echocardiographic, and electrocardiographic characteristics is useful for predicting future PeAF in patients with a dual-chamber PM.
AB - Persistent atrial fibrillation (PeAF) predictors after dual-chamber pacemaker (PM) implantation remain unclear. We sought to determine these predictors and establish an integrated scoring model. Data were retrospectively reviewed for 649 patients (63.8 ± 12.3 years, 48.6% male, mean CHA2DS2-VASC score 2.7 ± 2.0) undergoing dual-chamber PM implantation. PeAF was defined as documented AF on two consecutive electrocardiograms acquired ≥7 days apart. During a 7.1-year median follow-up (interquartile range 4.5-10.1 years), 67 (10.3%) patients had PeAF. Multivariable analysis showed the following independent predictors of future PeAF: ischemic stroke or transient ischemic accident history (hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.03-3.50, p = 0.040), atrial fibrillation/flutter history (HR 1.80, 95% CI 1.01-3.20, p = 0.046), sinus node disease (HR 2.24, 95% CI 1.16-4.35, p = 0.016), left atrial enlargement (>45 mm, HR 2.14, 95% CI 1.26-3.63, p = 0.005), and time in automatic mode switching >1% at first follow-up interrogation (HR 2.58, 95% CI 1.51-4.42, p < 0.001). An integrated scoring model combining these predictors showed good discrimination performance at the seven-year follow-up. (C-statistic 0.716, 95% CI 0.629-0.802, p < 0.001). Significantly greater seven-year PeAF incidences were seen in patients with higher scores (2-5) than in those with lower scores (0-1) (22.8% ± 3.8% vs. 5.3% ± 1.7%, p < 0.001). In conclusion, an integrated scoring model combining clinical, echocardiographic, and electrocardiographic characteristics is useful for predicting future PeAF in patients with a dual-chamber PM.
UR - http://www.scopus.com/inward/record.url?scp=84982133309&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0160422
DO - 10.1371/journal.pone.0160422
M3 - Article
C2 - 27479069
AN - SCOPUS:84982133309
SN - 1932-6203
VL - 11
JO - PLoS ONE
JF - PLoS ONE
IS - 8
M1 - e0160422
ER -