이달의 kcj Hot Article / 2024년 1월
Risk of Atrial Fibrillation and Adverse Outcomes in Patients With Cardiac Implantable Electronic Devices |
| 저자 |
So-Ryoung Lee, MD, PhD,1,2,* Ji Hyun Lee, MD, PhD,3,* Eue-Keun Choi, MD, PhD,1,2 Eun-Kyung Jung, BS,4 So-Jeong You, BS,4 Seil Oh, MD, PhD,1,2 and Gregory YH Lip, MD1,5,6 |
| 소속 |
1Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
3Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
4Medtronic Korea, Ltd., Seoul, Korea.
5Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, Liverpool, United Kingdom.
6Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. |
Background and ObjectivesComprehensive epidemiological data are lacking on the incident atrial fibrillation (AF) in patients with cardiac implantable electronic devices (CIEDs). This study aimed to examine the incidence, risk factors, and AF-related adverse outcomes of patients with CIEDs. MethodsThis was an observational cohort study that analyzed patients without prevalent AF who underwent CIED implantation in 2009–2018 using a Korean nationwide claims database. The subjects were divided into three groups by CIED type and indication: pacemaker (n=21,438), implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT) with heart failure (HF) (n=3,450), and ICD for secondary prevention without HF (n=2,146). The incidence of AF, AF-associated predictors, and adverse outcomes were evaluated. ResultsDuring follow-up, the incidence of AF was 4.3, 7.3, and 5.1 per 100 person-years in the pacemaker, ICD/CRT with HF, and ICD without HF cohorts, respectively. Across the three cohorts, older age and valvular heart disease were commonly associated with incident AF. Incident AF was consistently associated with an increased risk of ischemic stroke (3.8–11.4-fold), admission for HF (2.6–10.5-fold), hospitalization for any cause (2.4–2.7-fold), all-cause death (4.1–5.0-fold), and composite outcomes (3.4–5.7-fold). Oral anticoagulation rates were suboptimal in patients with incident AF (pacemaker, 51.3%; ICD/CRT with HF, 51.7%; and ICD without HF, 33.8%, respectively). ConclusionsA substantial proportion of patients implanted CIED developed newly diagnosed AF. Incident AF was associated with a higher risk of adverse events. The importance of awareness, early detection, and appropriate management of AF in patients with CIED should be emphasized.
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