Rate- and Rhythm Therapy in Patients with Atrial Fibrillation and the Risk of Pacing and Bradyarrhythmia

Frederik Dalgaard, Jannik L Pallisgaard, Tommi Bo Lindhardt, Christian Torp-Pedersen, Gunnar H Gislason, Martin H Ruwald

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: Management of atrial fibrillation (AF) with rate and rhythm therapy can cause bradyarrhythmia. Objectives: To assess overall risk, temporal risk, and subgroup at risk of bradyarrhythmia-related events by rate and/or rhythm therapy drugs. Methods: Using Danish nationwide registries, patients with AF between 2000 and 2014 were included if prescribed with rate-lowering drugs (RLDs) or antiarrhythmic drugs (AADs). An adjusted time-dependent Poisson regression model estimated the association between RLDs and AADs with a composite endpoint of pacemaker, temporary pacing, and bradyarrhythmia hospitalization. Secondary outcomes were each individual event. Results: Among 135,017 AF patients, 9196 (6.8%) patients experienced the composite endpoint with a median follow-up of 3.7 (interquartile range [IQR]: 1.6–7.0) years. Median age was 74 (IQR: 65–82) years and 47.6% were women. With rate-lowering monotherapy as the reference, the incidence rate ratios (IRR) (95% confidence interval) for the composite endpoint were 1.36 (1.29–1.43) for rate-lowering dual therapy, 1.62 (1.43–1.84) for antiarrhythmic monotherapy, and 2.49 (2.29–2.71) for AAD combined with RLDs. Similar trend was found for each secondary outcome. Particularly amiodarone increased the risk. This association was strongest within the first 2 weeks of treatment. In those treated with AAD combined with RLDs, high-risk populations were patients ≥70 years (IRR: 3.35 [2.51–4.45] compared to patients <60 years), and women (IRR: 1.35 [1.15–1.57], compared to men). Conclusions: In real-world AF patients, rate-lowering dual therapy, antiarrhythmic monotherapy, and AADs combined with RLDs were positively associated with bradyarrhythmia-related events. The risk was highest in those treated with amiodarone, in the initial 2 weeks of treatment, in women, and in the elderly.

Original languageEnglish
JournalHeart Rhythm
Volume16
Issue number9
Pages (from-to)1348-1356
Number of pages9
ISSN1547-5271
DOIs
Publication statusPublished - Sep 2019

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Bradycardia
Anti-Arrhythmia Agents
Atrial Fibrillation
Pharmaceutical Preparations
Amiodarone
Incidence
Therapeutics
Registries
Hospitalization
Confidence Intervals
Drug Therapy
Population

Bibliographical note

Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Keywords

  • Antiarrhythmic drugs
  • Atrial fibrillation
  • Bradyarrhythmia
  • Pacemaker
  • Rate-lowering drugs

Cite this

Dalgaard, Frederik ; Pallisgaard, Jannik L ; Lindhardt, Tommi Bo ; Torp-Pedersen, Christian ; Gislason, Gunnar H ; Ruwald, Martin H. / Rate- and Rhythm Therapy in Patients with Atrial Fibrillation and the Risk of Pacing and Bradyarrhythmia. In: Heart Rhythm. 2019 ; Vol. 16, No. 9. pp. 1348-1356.
@article{26ddc6b20bb54f9d82ce43b96ca48451,
title = "Rate- and Rhythm Therapy in Patients with Atrial Fibrillation and the Risk of Pacing and Bradyarrhythmia",
abstract = "Background: Management of atrial fibrillation (AF) with rate and rhythm therapy can cause bradyarrhythmia. Objectives: To assess overall risk, temporal risk, and subgroup at risk of bradyarrhythmia-related events by rate and/or rhythm therapy drugs. Methods: Using Danish nationwide registries, patients with AF between 2000 and 2014 were included if prescribed with rate-lowering drugs (RLDs) or antiarrhythmic drugs (AADs). An adjusted time-dependent Poisson regression model estimated the association between RLDs and AADs with a composite endpoint of pacemaker, temporary pacing, and bradyarrhythmia hospitalization. Secondary outcomes were each individual event. Results: Among 135,017 AF patients, 9196 (6.8{\%}) patients experienced the composite endpoint with a median follow-up of 3.7 (interquartile range [IQR]: 1.6–7.0) years. Median age was 74 (IQR: 65–82) years and 47.6{\%} were women. With rate-lowering monotherapy as the reference, the incidence rate ratios (IRR) (95{\%} confidence interval) for the composite endpoint were 1.36 (1.29–1.43) for rate-lowering dual therapy, 1.62 (1.43–1.84) for antiarrhythmic monotherapy, and 2.49 (2.29–2.71) for AAD combined with RLDs. Similar trend was found for each secondary outcome. Particularly amiodarone increased the risk. This association was strongest within the first 2 weeks of treatment. In those treated with AAD combined with RLDs, high-risk populations were patients ≥70 years (IRR: 3.35 [2.51–4.45] compared to patients <60 years), and women (IRR: 1.35 [1.15–1.57], compared to men). Conclusions: In real-world AF patients, rate-lowering dual therapy, antiarrhythmic monotherapy, and AADs combined with RLDs were positively associated with bradyarrhythmia-related events. The risk was highest in those treated with amiodarone, in the initial 2 weeks of treatment, in women, and in the elderly.",
keywords = "Antiarrhythmic drugs, Atrial fibrillation, Bradyarrhythmia, Pacemaker, Rate-lowering drugs",
author = "Frederik Dalgaard and Pallisgaard, {Jannik L} and Lindhardt, {Tommi Bo} and Christian Torp-Pedersen and Gislason, {Gunnar H} and Ruwald, {Martin H}",
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Rate- and Rhythm Therapy in Patients with Atrial Fibrillation and the Risk of Pacing and Bradyarrhythmia. / Dalgaard, Frederik; Pallisgaard, Jannik L; Lindhardt, Tommi Bo; Torp-Pedersen, Christian; Gislason, Gunnar H; Ruwald, Martin H.

In: Heart Rhythm, Vol. 16, No. 9, 09.2019, p. 1348-1356.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Rate- and Rhythm Therapy in Patients with Atrial Fibrillation and the Risk of Pacing and Bradyarrhythmia

AU - Dalgaard, Frederik

AU - Pallisgaard, Jannik L

AU - Lindhardt, Tommi Bo

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar H

AU - Ruwald, Martin H

N1 - Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

PY - 2019/9

Y1 - 2019/9

N2 - Background: Management of atrial fibrillation (AF) with rate and rhythm therapy can cause bradyarrhythmia. Objectives: To assess overall risk, temporal risk, and subgroup at risk of bradyarrhythmia-related events by rate and/or rhythm therapy drugs. Methods: Using Danish nationwide registries, patients with AF between 2000 and 2014 were included if prescribed with rate-lowering drugs (RLDs) or antiarrhythmic drugs (AADs). An adjusted time-dependent Poisson regression model estimated the association between RLDs and AADs with a composite endpoint of pacemaker, temporary pacing, and bradyarrhythmia hospitalization. Secondary outcomes were each individual event. Results: Among 135,017 AF patients, 9196 (6.8%) patients experienced the composite endpoint with a median follow-up of 3.7 (interquartile range [IQR]: 1.6–7.0) years. Median age was 74 (IQR: 65–82) years and 47.6% were women. With rate-lowering monotherapy as the reference, the incidence rate ratios (IRR) (95% confidence interval) for the composite endpoint were 1.36 (1.29–1.43) for rate-lowering dual therapy, 1.62 (1.43–1.84) for antiarrhythmic monotherapy, and 2.49 (2.29–2.71) for AAD combined with RLDs. Similar trend was found for each secondary outcome. Particularly amiodarone increased the risk. This association was strongest within the first 2 weeks of treatment. In those treated with AAD combined with RLDs, high-risk populations were patients ≥70 years (IRR: 3.35 [2.51–4.45] compared to patients <60 years), and women (IRR: 1.35 [1.15–1.57], compared to men). Conclusions: In real-world AF patients, rate-lowering dual therapy, antiarrhythmic monotherapy, and AADs combined with RLDs were positively associated with bradyarrhythmia-related events. The risk was highest in those treated with amiodarone, in the initial 2 weeks of treatment, in women, and in the elderly.

AB - Background: Management of atrial fibrillation (AF) with rate and rhythm therapy can cause bradyarrhythmia. Objectives: To assess overall risk, temporal risk, and subgroup at risk of bradyarrhythmia-related events by rate and/or rhythm therapy drugs. Methods: Using Danish nationwide registries, patients with AF between 2000 and 2014 were included if prescribed with rate-lowering drugs (RLDs) or antiarrhythmic drugs (AADs). An adjusted time-dependent Poisson regression model estimated the association between RLDs and AADs with a composite endpoint of pacemaker, temporary pacing, and bradyarrhythmia hospitalization. Secondary outcomes were each individual event. Results: Among 135,017 AF patients, 9196 (6.8%) patients experienced the composite endpoint with a median follow-up of 3.7 (interquartile range [IQR]: 1.6–7.0) years. Median age was 74 (IQR: 65–82) years and 47.6% were women. With rate-lowering monotherapy as the reference, the incidence rate ratios (IRR) (95% confidence interval) for the composite endpoint were 1.36 (1.29–1.43) for rate-lowering dual therapy, 1.62 (1.43–1.84) for antiarrhythmic monotherapy, and 2.49 (2.29–2.71) for AAD combined with RLDs. Similar trend was found for each secondary outcome. Particularly amiodarone increased the risk. This association was strongest within the first 2 weeks of treatment. In those treated with AAD combined with RLDs, high-risk populations were patients ≥70 years (IRR: 3.35 [2.51–4.45] compared to patients <60 years), and women (IRR: 1.35 [1.15–1.57], compared to men). Conclusions: In real-world AF patients, rate-lowering dual therapy, antiarrhythmic monotherapy, and AADs combined with RLDs were positively associated with bradyarrhythmia-related events. The risk was highest in those treated with amiodarone, in the initial 2 weeks of treatment, in women, and in the elderly.

KW - Antiarrhythmic drugs

KW - Atrial fibrillation

KW - Bradyarrhythmia

KW - Pacemaker

KW - Rate-lowering drugs

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U2 - 10.1016/j.hrthm.2019.05.018

DO - 10.1016/j.hrthm.2019.05.018

M3 - Journal article

VL - 16

SP - 1348

EP - 1356

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 9

ER -