Predictors for atrial fibrillation onset in CKD patients with pacemaker

Abstract

Aim: To assess the hypothesis that chronic kidney disease (CKD) may affect the incidence of AF, the present study investigated the influence of renal impairment and CKD on the new onset of AF in this population. Methods:A cohort of inividuals received standard therapy for treatment of sinus node disease (SND), and second-or third-degree atrioventricular block (AVB), DDDR pacemaker implantation. The maximum follow-up period was 6 years after the implantation procedure.Results: CKD, age, hypertension, smoking, left ventricular mass index (LVMI), left atrial diameter (LAD), and pacemakers implanted due to 2 nd or 3 rd degree AVB were significantly different (defined as P<0.1) between the no CKD and CKD population in the univariate Cox logistic regression model. All of them except hypertension were significant (P<0.05) in the multivariate Cox logistic regression model. Independent predictors of AF incidence were re-examined by stepwise regression analysis including all clinical and echocardiographic variables as possible independent factors. The presence of CKD as well as age, smoking, LVMI, LAD, and AVB was an independent predictor of new-onset AF (age, hazard ratio (HR): 1.031, 95% confidence interval (CI): 1.023 -1.038, P<0.0001; smoking, HR: 1.315, 95%CI: 1.110 -1.558, P=0.0020; LVMI, HR:1.017, 95%CI: 1.013 -1.020, P=0.0020; LAD, HR: 1.281, 95%CI: 1.241 -1.322, P<0.0001; AVB, HR: 1.240, 95%CI: 1.087 -1.415, P=0.0010; and CKD, HR: 2.073, 95% CI: 1.616 -2.660, P<0.0001). The association of CKD stages with the incidence of AF was lastly evaluated by the univariate Cox analysis, the occurrence of new-onset AF was significantly increased in the participant groups with CKD stage 3, 4 and 5 before and after adjustment for confounding factors, being significantly associated with the increased incidence of AF. Conclusions:The present study demonstrated that CKD was associated with an increased risk of new onset AF in patients with pacemakers and that the impact of CKD on the incidence of AF was independent of LV hypertrophy and LA dilatation. In particular, moderate to later stages of CKD were strongly related to the increasing occurrence of AF.