loading page

Paced P-wave duration as a significant predictor for atrial high-rate episodes in patients with cardiac implantable electronic devices
  • +5
  • Jose Manuel Rubio,
  • Alberto Sánchez Arjona,
  • Camila García-Talavera,
  • Loreto Bravo Calero,
  • Carla Lázaro Rivera,
  • Francisco Díaz Cortegana,
  • José Tuñón,
  • Adrian Baranchuk
Jose Manuel Rubio
Hospital Universitario Fundacion Jimenez Diaz

Corresponding Author:[email protected]

Author Profile
Alberto Sánchez Arjona
Hospital Universitario Fundacion Jimenez Diaz
Author Profile
Camila García-Talavera
Hospital Universitario Fundacion Jimenez Diaz
Author Profile
Loreto Bravo Calero
Hospital Universitario Fundacion Jimenez Diaz
Author Profile
Carla Lázaro Rivera
Hospital Universitario Fundacion Jimenez Diaz
Author Profile
Francisco Díaz Cortegana
Hospital Universitario Fundacion Jimenez Diaz
Author Profile
José Tuñón
Hospital Universitario Fundacion Jimenez Diaz
Author Profile
Adrian Baranchuk
Kingston Health Sciences Centre
Author Profile

Abstract

Introduction: Atrial pacing can unmask or aggravate a preexisting interatrial block (IAB). Our study aimed to determine whether atrial pacing is associated with the development of atrial high-rate episodes (AHRE) during follow-up. Methods and Results: Patients with dual-chamber cardiac implantable electronic devices (CIED), no previous documented atrial fibrillation, and with a 6-month minimum follow-up were included. In all patients, sinus and paced P-wave duration was measured. AHRE was defined as an episode of atrial rate ≥ 225 bpm with a minimum duration of 5 min, excluding those documented during the first three months after implantation. Two hundred twenty patients were included (75 ± 10 years, 61% male). After a mean follow-up of 59±25 months, 46% of patients presented AHRE. Mean paced P-wave duration was significantly longer than the sinus P-wave duration (154±27 vs 115±18 ms; p < 0.001). Sinus and paced P-waves were significantly longer in those who developed AHRE (sinus: 119±20 vs 112±16; p = 0.006; paced: 161±29 vs 148±23; p < 0.001). A paced P-wave ≥160 ms was the best predictor of AHRE, especially those lasting >24 h (OR 4.2 (95% CI) [1.6-11.4]; p = 0.004). Conclusion: Atrial pacing significantly prolongs P-wave duration and is associated with further development of AHRE. A paced P-wave ≥160 ms is a strong predictor of AHRE and should be taken into consideration as a new definition of IAB in the presence of atrial pacing.