Incidence of atrial fibrillation in patients with sinus node dysfunction with a different mode of pacing

Abstract

Objectives: The aim of our study was to evaluate the incidence of atrial fibrillation (AF) during a longterm follow-up in patients with different modes of pacing and the relation between AF and the presence of ventriculoatrial (VA) conduction. Design, Methods and Results:We evaluated the incidence of AF in 1921 patients (982 males, 939 females; mean age 73.4±4.5 years) with sinus node dysfunction (SND) and a pacemaker, during a mean follow-up period of 5.1 ± 2.8 years. AF occurred in 494 patients (pts) with an overall incidence of 25.7 percent. Considering a mode of pacing, the lower incidence of AF was found in patients with AAI pacing (17.3%) while higher rates were present in the VVI mode (26.7%), VVIR (22.8%) and DDD (20.2%). In the VVI mode group, VA conduction was present in 310 pts of 1570 (19.7%), AF occurred in 211 pts (68.0%). In the VVIR group, VA conduction was present in 39 pts of 210, AF occurred in 30 pts of 39 (76.9%). Concerning the presence or absence of VA conduction in patients with the VVI and VVIR pacing modes, our results showed the highest prevalence of AF in patients with AV conduction (overall AF occurred in 8.3% of 1431 pts without VA conduction versus 241 pts (69.0%) of 349 with VA conduction). Conclusion: Our study confirmed that patients with sinus node dysfunction were at high risk for AF. The incidence of AF was the highest in patients with the VVI and VVIR pacing modes and in the presence of VA conduction. AF can be prevented by ensuring that patients receive an appropriate pacemaker and by programming the pacemaker to avoid atrioventricular dyssynchrony.