Review of the epidemiology, pathogenesis and prevention of atrial fibrillation after pacemaker implantation

Abstract

Cardiac pacemaker implantation is an important treatment for symptomatic bradycardia. However, epidemiological data show that the incidence of atrial fibrillation (AF) is significantly higher in patients with implanted pacemakers than in the general population, which may be related to the preoperative presence of multiple risk factors for AF, improvement of diagnostic sensitivity and the pacemaker itself. The pathogenesis of AF after the implantation of pacemaker is related to cardiac electrical remodeling, structural remodeling, inflammation, and autonomic nervous disorder, which are induced by the pacemaker. Moreover, different pacing modes and pacing sites have various effects on the pathogenesis of postoperative AF. Recent studies have reported that reducing the proportion of ventricular pacing, improving the pacing site and setting up special pacing procedures might be highly useful in prevention of AF after pacemaker implantation. This article reviews the epidemiology, pathogenesis, influencing factors, and preventive measures regarding AF after pacemaker surgery.

Effects of ACEI/ARB or CCB use on atrial fibrillation in hypertensive patients following permanent pacemaker implantation

“…The exogenous stimulation from the pacemaker implantation induce an inflammatory response, which could lead to the increased release of inflammatory mediators such as interleukin-6 (IL-6), tumor necrosis factor-alpha, and C-reactive protein, thereby downregulating the expression of cellular junction proteins and promoting abnormity in cardiac electrical conductivity. The rest of mechanisms also include autonomic nervous disorder (like sympathetic activation), etc ( 17 ).…”