Impact of atrial high-rate episodes on new onset of atrial fibrillation and all-cause mortality in elderly patients over 90 years old with dual-chamber pacemaker implantation
Impact of atrial high-rate episodes on new onset of atrial fibrillation and all-cause mortality in elderly patients over 90 years old with dual-chamber pacemaker implantation
Objective To investigate the impacts of atrial high-rate episodes(AHRE)on the risks of new onset of atrial fibrillation and all-cause mortality in elderly patients over 90 years old after cardiac dual-chamber pacemaker implantation.Methods This study was a retrospective study.Patients aged 90 years and above who were implanted with cardiac dual-chamber pacemakers and followed up in the People's Liberation Army General Hospital from January 2017 to June 2022 were enrolled and divided into AHRE≥6 h group and AHRE＜6 h group according to the onset time of AHRE.The primary endpoint was new onset of atrial fibrillation,and the secondary endpoints were all-cause mortality and cardiovascular mortality.Kaplan-Meier survival curve was poltted,and log-rank test was used to compare the differences in the incidence of new onset of atrial fibrillation,all-cause death and cardiovascular death between AHRE≥6 h and AHRE＜6 h groups.Multivariate Cox survival analysis was used to investigate the factors affecting new onset of atrial fibrillation,all-cause death and cardiovascular death in elderly patients aged 90 years and above with dual-chamber pacemaker implantation.Results A total of 169 patients were enrolled,aged(93.95±3.28)years,including 18 females(11％).The median follow-up time was 28.9 months.There were 87 and 82 patients in AHRE≥6 h group and AHRE＜6 h group,respectively.Kaplan-Meier survival curve analysis showed that the incidence of new onset of atrial fibrillation(log-rank P＜0.001),all-cause death(log-rank P=0.004)and cardiovascular death(log-rank P=0.026)in AHRE≥6 h group was significantly higher than that in AHRE＜6 h group.After adjusting for traditional risk factors,multivariate Cox survival analysis showed that AHRE≥6 h was an independent risk factor for new onset of atrial fibrillation(HR=4.046,95％CI 2.402-6.814,P＜0.001)and all-cause mortality(HR=1.668,95％CI1.119-2.487,P=0.012)in elderly patients over 90 years old with cardiac dual-chamber pacemaker implantation.However,AHRE≥6 h had no effect on cardiovascular mortality(P＞0.05).Anemia(HR=3.098,95％CI 1.342-7.153,P=0.008)and heart failure with reduced ejection fraction(HR=3.028,95％CI 1.181-7.763,P=0.021)were both independently associated with cardiovascular mortality.Conclusions AHRE is common in cardiac dual-chamber pacemakers recipients aged 90 years and above,and AHRE≥6 h can be used as a predictor of new onset of atrial fibrillation or all-cause mortality in these patients.
维普
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