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Antiarrhythmic Drugs and Syncope or Pacemaker Implant in AF
Quick Takes
- In a large cohort of patients diagnosed with AF in the preceding 1 year, there is a strong association between antiarrhythmic drug (AAD) use and the risk of pacemaker implantation or syncope.
- Use of AAD was associated with 3.5-, 2.0-, and 5.0-fold increased risk of pacemaker implantation or syncope, syncope, and pacemaker implantation, respectively.
Study Questions:
What is the association between antiarrhythmic drug (AAD) use and the risk of pacemaker implantation or syncope in patients with new-onset atrial fibrillation (AF) receiving early rhythm control therapy with AADs?
Methods:
The authors analyzed data in the Korean National Health Insurance Service system and identified patients who were prescribed AADs within 1 year of AF diagnosis. The risk of pacemaker implantation or syncope was compared between AAD users and nonusers.
Results:
A total of 770,977 new-onset AF cases were identified and 142,141 patients were prescribed AADs. After multivariate adjustment, use of AADs was associated with 3.5-, 2.0-, and 5.0-fold increased risk of pacemaker implantation or syncope, syncope, and pacemaker implantation, respectively. Propensity score-matched analysis revealed similar results, demonstrating a significant association between AAD use and the risk of pacemaker implantation or syncope. This association was consistent across various subgroups. Women were more susceptible to adverse effects of AADs than men.
Conclusions:
The authors conclude that there is an association between AADs and risk of pacemaker implantation or syncope.
Perspective:
Many patients with AF have concomitant sinus node dysfunction. One of the most frequent adverse effects of AADs is bradycardia due to their negative chronotropic and dromotropic effects. The present study shows that in a large nationwide cohort of patients with a recent diagnosis of AF, AAD treatment is associated with increased risk of syncope and pacemaker implantation. The association was consistent across various subgroups. Older patients and women appeared to be more susceptible to the adverse effects of the AADs. These findings may inform the risk/benefit assessment when reasonable approaches to AF management include AF ablation or AAD, especially if the findings of the present report are confirmed in properly designed prospective randomized studies.
Clinical Topics: Arrhythmias and Clinical EP, EP Basic Science, Anticoagulation Management and Atrial Fibrillation
Keywords: Anti-Arrhythmia Agents, Pacemaker, Artificial, Syncope
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