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/m2(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/m2) 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/m2) independently predicted new-onset AF and may provide an approach to clinically useful risk assessment for incident AF.