Risk of Atrial Fibrillation and Adverse Outcomes in Patients With Cardiac Implantable Electronic Devices.

Lee, So-Ryoung ORCID: 0000-0002-6351-5015, Lee, Ji Hyun ORCID: 0000-0002-7162-1248, Choi, Eue-Keun ORCID: 0000-0002-0411-6372, Jung, Eun-Kyung, You, So-Jeong ORCID: 0000-0002-3760-943X, Oh, Seil ORCID: 0000-0002-2504-9615 and Lip, Gregory Yh ORCID: 0000-0002-7566-1626 (2024) Risk of Atrial Fibrillation and Adverse Outcomes in Patients With Cardiac Implantable Electronic Devices. Korean circulation journal, 54 (1). pp. 13-27.

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Official URL: http://dx.doi.org/10.4070/kcj.2023.0084

Abstract

<h4>Background and objectives</h4>Comprehensive epidemiological data are lacking on the incident atrial fibrillation (AF) in patients with cardiac implantable electronic devices (CIEDs). This study aimed to examine the incidence, risk factors, and AF-related adverse outcomes of patients with CIEDs.<h4>Methods</h4>This was an observational cohort study that analyzed patients without prevalent AF who underwent CIED implantation in 2009-2018 using a Korean nationwide claims database. The subjects were divided into three groups by CIED type and indication: pacemaker (n=21,438), implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT) with heart failure (HF) (n=3,450), and ICD for secondary prevention without HF (n=2,146). The incidence of AF, AF-associated predictors, and adverse outcomes were evaluated.<h4>Results</h4>During follow-up, the incidence of AF was 4.3, 7.3, and 5.1 per 100 person-years in the pacemaker, ICD/CRT with HF, and ICD without HF cohorts, respectively. Across the three cohorts, older age and valvular heart disease were commonly associated with incident AF. Incident AF was consistently associated with an increased risk of ischemic stroke (3.8-11.4-fold), admission for HF (2.6-10.5-fold), hospitalization for any cause (2.4-2.7-fold), all-cause death (4.1-5.0-fold), and composite outcomes (3.4-5.7-fold). Oral anticoagulation rates were suboptimal in patients with incident AF (pacemaker, 51.3%; ICD/CRT with HF, 51.7%; and ICD without HF, 33.8%, respectively).<h4>Conclusions</h4>A substantial proportion of patients implanted CIED developed newly diagnosed AF. Incident AF was associated with a higher risk of adverse events. The importance of awareness, early detection, and appropriate management of AF in patients with CIED should be emphasized.

Item Type:	Article
Uncontrolled Keywords:	Atrial fibrillation, Cardiac resynchronization therapy, Implantable cardioverter defibrillator, Pacemaker, Risk factor
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	02 Feb 2024 11:40
Last Modified:	02 Feb 2024 11:40
DOI:	10.4070/kcj.2023.0084
Open Access URL:	https://doi.org/10.4070/kcj.2023.0084
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3178340