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Title: Risk factors for permanent and persistant atrial fibrillation in elderly patients with SSS after dual chamber pacemaker implantation

Michał Chudzik, Jerzy Krzysztof Wranicz, Artur Klimczak, Andrzej Oszczygieł, Jan Henryk Goch
Original articles
Polish Journal of Cardiology
Start page:
Final page:
atrial fibrillation, atrial based pacing, pacemaker in the elderly

Introduction: The mayority of pacemaker (PM) recipients are at least 65 years old.The reduction of incidents of atrial fibrillation (AF) is very important, especially in the elderly patients (pts) because this arrhythmia is associated with greater morbidity and mortality than in younger population. At the other hand dual chamber pacemaker (DDD PM) in the elderly is still controversial because of its short life expectance and the high risk of AF. Previous studies have shown that there are some factors which can predict atrial fibrillation in elderly pts after pacemaker implantation and we are able to identify pts who will maintain sinus rhythm for long term follow up. Aim of study: The aim of the study was to evaluate the risk factors for permanent and persitent AF during 1 year follow up in elderly patients (over 75 years old) after DDD PM implantation. Materiał and methods: We examined 50 pts with sick sinus syndrome (SSS), with mean age 79.2±6 years, im-planted with DDD PM (Biotronik Axios D (R), during the mean follow up 14±4.5 months (from 12.5 to 20 months). SSS with documented previous AF episides was indication for DDD PM in all pts. The number of patients with atrial arrhythmias during pacemaker follow up and 24 hours Holter monitoring at the dischar-geand attheend of the study were estimated. In case when cardioversion was notsuccessful, PM was re-programmed to Wl modę. Results: In 13 (27%) pts AF during 1 year FU was recognized. In 7 pts successful electrical cardioversion was performed. In others 6 pts sinus rhythm was not restored, and PM was reprogrammed to Wl modę. Patients who developed permanent AF comparing to pts with sinus rhythm had significant morę frequent preimplant episodesof AF(92% vs 16%; p=0.001), higher mean values of P wave duration (P=120 ms vs P=91.7 ms; p=0.003)and larger left atrial diameter in ECHO study (51 mm vs43.4 mm; p=0.026). There were no other significant differences in clinical and ECHO parameters between pts with and without AF. Additionally, all pts with persistent AF had P wave duration above 120 ms. Conclusions: Preimplant frequent episodes of AF, P wave prolongation and increased LA diameter in elderly pts with sinus node dysfunction after dual chamber pacemaker implantation are the main atrial arrhythmia predictors during 1-year follow up.