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

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/m (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/m) 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/m) independently predicted new-onset AF and may provide an approach to clinically useful risk assessment for incident AF.