Pacemakers may be an effective treatment option for atrial fibrillation patients with bradycardia or atrioventricular block (electrical conduction disturbance between the atria and ventricles). The electrical stimulation provided by the pacemaker can restore and maintain a regular heart rhythm in these cases.
High atrial rate episodes detected by cardiac implantable electronic devices may be associated with a risk of progression to long-duration (≥24 h) episodes of clinical atrial fibrillation. In 24 patients with iimplantable cardioverter defibrillators and consecutive implanted pacemakers, five electrograms of atrial fibrillation episodes longer than 5 min over 427 days were analysed, as well as the medical history of all patients, the recording of daily activity and all episodes and their duration over the time period analysed. The objective was to identify possible predictors of the evolution of atrial fibrillation and the evolution of atrial fibrillation to long-lasting episodes. During a median follow-up of 427 days, 30% of patients experienced the composite outcome of clinical episodes of AF lasting ≥24 h. Longer duration of episodes of atrial activity was independently associated with the composite outcome of higher recurrence of atrial fibrillation episodes, higher atrial rate and its greater signal irregularity. In conclusion, continuous monitoring of patients and the duration and rapidity of atrial episodes may help to intensify monitoring and decision-making, being independently associated with clinical AF in follow-up of more than 400 days.