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Risk factors for the development of incident atrial fibrillation in patients with cardiac implantable electronic devices

  • Kazuo Miyazawa
    Correspondence
    Corresponding author at: University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, England, United Kingdom.
    Affiliations
    Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom

    Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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  • Yusuke Kondo
    Affiliations
    Department of Advanced Cardiovascular Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
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  • Miyo Nakano
    Affiliations
    Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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  • María Asunción Esteve-Pastor
    Affiliations
    Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom

    Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
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  • José Miguel Rivera-Caravaca
    Affiliations
    Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom

    Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
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  • Keitaro Senoo
    Affiliations
    Department of Advanced Cardiovascular Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan

    Department of Arrhythmia, Koseika Takeda Hospital, Kyoto, Japan
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  • Yoshio Kobayashi
    Affiliations
    Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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  • Gregory Y.H. Lip
    Affiliations
    Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom

    Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Published:February 26, 2018DOI:https://doi.org/10.1016/j.ejim.2018.02.019

      Highlights

      • New-onset AF was detected in 21% of patients with CIEDs.
      • Age, diabetes mellitus, heart failure, and left atrial enlargement predicted new-onset AF.
      • Four clinical factors provide clinically useful risk assessment of new-onset AF.

      Abstract

      Introduction

      Cardiac implantable electronic devices (CIEDs) can detect atrial fibrillation (AF) early and accurately. Risk factors for the development of new-onset AF in patients with CIEDs remains uncertain.

      Methods

      Patients with CIEDs who visited Chiba University Hospital between January 2016 and December 2016 were enrolled. We only included patients without single chamber CIEDs or a known history of AF.

      Results

      Of 371 patients with CIEDs, 78 (21.0%; median age 61.0 years, 65.5% male) developed new-onset AF. Multivariate analysis demonstrated that independent predictors for the development of new or incident AF were age ≥65 years (odd ratio [OR] 2.76, 95% confidence interval [CI] 1.54–4.96, P = 0.001), diabetes mellitus (OR 2.24, 95% CI 1.20–4.19, P = 0.011), congestive heart failure (OR 1.94, 95% CI 1.06–3.54, P = 0.031), and left atrial volume index >34 ml/m2 (OR 3.51, 95% CI 1.96–6.25, P < 0.001). Based on these 4 clinical factors (age ≥ 65, diabetes mellitus, congestive heart failure, left atrial volume index > 34 ml/m2) there was a good predictive ability for new AF development (AUC 0.728) and clinically usefulness using decision curve analysis.

      Conclusions

      A substantial number of patients with CIEDs develop new-onset AF. Four clinical factors (age ≥ 65, diabetes mellitus, congestive heart failure, left atrial volume index > 34 ml/m2) independently predicted new-onset AF and may provide an approach to clinically useful risk assessment for incident AF.

      Keywords

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