Predictors and long-term clinical outcomes of newly developed atrial fibrillation in patients with cardiac implantable electronic devices.

objectiveTo evaluate predictors and long-term prognosis of atrial fibrillation (AF) following cardiac implantable electronic device (CIED) implantation in patients without history of AF.

methodsFrom May 1994 to April 2014, 1825 patients with CIED were enrolled in a retrospective, single-center registry. A total of 880 patients from the registry without prior documented AF history were included in the final analysis and were placed into either non-detected AF (NDAF) group or CIED-detected AF group according to development of AF over a follow-up period of 7 years. AF development was defined as any paroxysmal atrial tachyarrhythmia (atrial rate ≥ 180 beats/min) lasting at least 5 minutes according to CIED records.

resultsOverall, 122 (13.8%) of the 880 patients experienced new development of AF during follow-up period. According to multivariate analysis, the independent predictors for development of AF were prior heart failure (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.50-3.85; P < 0.001), prior sinus node dysfunction (HR, 2.33; 95% CI, 1.62-3.55; P < 0.001), and left atrium volume index of 38.5 mL/m or more (HR, 2.01; 95% CI, 1.23-3.30; P = 0.005). In CDAF group, the risk of heart failure readmission (adjusted HR, 3.79; 95% CI, 1.99-7.22; P < 0.001) and stroke readmission (adjusted HR, 5.33; 95% CI, 1.58-17.97; P = 0.007) was higher than in nondetected AF group.

conclusionIn patients with CIED, prior history of heart failure, sinus node dysfunction, and LA volume index ≥38.5 mL/m were independent predictors of new AF cases. Newly developed AF was significantly associated with increased risk of HF and stroke readmission, according to long-term follow up.