Association between routine biomarkers and atrial fibrillation in patients undergoing implantation of a dual-chamber pacemaker

Konstantinos Kyrlas; Tong Liu; George Bazoukis; Sofia Plakoutsi; Evangelos Liberopoulos; Haralampos Milionis; Panagiotis Korantzopoulos

doi:10.1002/joa3.12479

Association between routine biomarkers and atrial fibrillation in patients undergoing implantation of a dual-chamber pacemaker

J Arrhythm. 2020 Dec 17;37(1):219-225. doi: 10.1002/joa3.12479. eCollection 2021 Feb.

Authors

Konstantinos Kyrlas¹, Tong Liu², George Bazoukis^{1

3}, Sofia Plakoutsi¹, Evangelos Liberopoulos⁴, Haralampos Milionis⁵, Panagiotis Korantzopoulos¹

Affiliations

¹ First Department of Cardiology University of Ioannina Medical School Ioannina Greece.
² Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of Cardiology Tianjin Institute of Cardiology Second Hospital of Tianjin Medical University Tianjin China.
³ Second Department of Cardiology "Evangelismos" General Hospital of Athens Athens Greece.
⁴ Second Department of Internal Medicine University of Ioannina Medical School Ioannina Greece.
⁵ First Department of Internal Medicine University of Ioannina Medical School Ioannina Greece.

Abstract

Background: Elderly patients having a permanent pacemaker frequently have atrial remodeling. We examined the association between routine biomarkers and atrial fibrillation (AF) in patients receiving a dual-chamber pacemaker for sinus node disease (SND) or second-/third-degree atrioventricular block.

Methods: We recorded clinical, laboratory, and electrocardiographic parameters as well as pacemaker lead parameters at implantation. The final analysis included 217 patients with SND and 393 patients with atrioventricular block. Notably, 102/217 (47%) of the SND patients (median age: 77 years, 54% men) and 54/393 (14%) of the atrioventricular block patients (median age: 79 years, 54% men) had AF history (paroxysmal or persistent).

Results: Multivariable analysis showed that red blood cell distribution width (RDW) (OR: 1.17; 95% CI: 1.05-1.36; P = .05) and serum γ-glutamyl transferase (γGT) levels (OR: 1.15; 95% CI: 1.03-1.28; P = .04) were independently associated with AF history in patients with SND. In ROC curve analysis, the area under the curve (AUC) was 0.648; P < .01 for RDW, and 0.753; P < .01 for γGT. A RDW cut-off point of 14 was associated with AF with a sensitivity of 67% and a specificity of 68%, while a γGT cut-off point of 21 was associated with AF with a sensitivity of 80% and a specificity of 65%. In patients with second-/third-degree atrioventricular block, there were no significant independent correlations between AF and the parameters studied.

Conclusions: In elderly patients with SND, RDW and γGT have an independent association with AF history. Our study failed to show any corresponding associations in patients with advanced disorders of atrioventricular conduction.

Keywords: RDW; atrial fibrillation; atrioventricular block; biomarkers; dual‐chamber pacemaker; electrocardiogram; implantation parameters; sick sinus syndrome; γ‐glutamyl transferase.