Risk Factors for Bradycardia Requiring Pacemaker Implantation in Patients With Atrial Fibrillation

Study Questions:

What are the predictors of the need for a pacemaker in patients with atrial fibrillation (AF)?


This was a retrospective analysis of 362 patients (mean age 65 years) with AF. Symptomatic bradycardia requiring pacemaker implantation occurred in 119 patients. These patients were compared to 243 control patients who did not undergo pacemaker implantation.


By multivariate analysis, there were two significant independent predictors of the need for a pacemaker: heart failure (odds ratio [OR], 2.7), and age at the time of AF diagnosis (OR, 1.02). With inclusion of the type of AF in the multivariate analysis, permanent AF also was a significant predictor of pacemaker implantation (OR, 3.0).


The authors concluded that heart failure and permanent AF are the strongest predictors of the need for a permanent pacemaker in patients with AF.


Heart failure and permanent AF both can cause atrial remodeling and scarring that could result in atrioventricular conduction slowing or block. The authors suggest that knowledge of these risk factors could allow early intervention with a pacemaker to prevent injuries caused by bradycardia-related syncope. However, regardless of these risk factors, pacemaker implantation would not be appropriate in the absence of a standard indication such as symptomatic bradycardia without a correctable cause or high-grade atrioventricular block.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, Acute Heart Failure

Keywords: Heart Failure, Risk Factors, Pacemaker, Artificial, Bradycardia

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