Association between paced QRS duration and atrial fibrillation after permanent pacemaker implantation: A retrospective observational cohort study

Abstract

Right ventricular pacing often results in prolonged QRS duration (QRSd) as the result of right ventricular stimulation, and atrial fibrillation (AF) may result. The association of pacing-induced prolonged QRSd and AF in patients with permanent pacemakers is unknown. We selected 180 consecutive patients who underwent pacemaker implantation for complete/advanced atrioventricular block. All of the patients were paced from the right ventricular septum. Electrocardiography recordings were obtained at the beginning and the end of pacemaker implantation. QRSd was measured in all 12 leads. The QRSd variation was calculated by subtracting the preimplantation QRSd from the postimplantation QRSd. The occurrence of AF was observed in 64 (35.56%) patients (follow-up 33.62±21.47 mo). No significant differences in preimplantation QRSd were observed between the AF occurrence and nonoccurrence groups. The QRSd variation in leads V4 (54.22±29.03 vs 42.66±33.79ms, P=.022), and V6 (64.62±23.16 vs 48.45±34.40ms, P=.001) differed significantly between the occurrence and nonoccurrence groups. More QRSd variation in lead V6 (P=.005, HR=1.822, 95% CI 1.174- 2.718, interval scale of QRSd was 40ms) and left atrial diameter (P=.045, HR=1.042, 95% CI 1.001-1.086) were independent risk factors for AF occurrence. Receiver operating characteristic curve suggested that QRSd variation in lead V6 could predict AF occurrence, especially for patientswith long preimplantationQRSd (=120ms, area under the curvewas 0.826, 95% CI 0.685-0.967). QRSd variation in lead V6 might be positively correlated with postimplantation AF occurrence. In patients with pacemaker implantation, QRSd could be a complementary criterion for optimizing the right ventricular septal pacing site, and smallest QRSd might be worth pursuing.