Abstract: Objective To investigate the incidence and risk factors of atrial high-rate episodes (AHREs) following dual-chamber pacemaker implantation in elderly patients. Methods This study retrospectively collected the clinical data of 107 patients aged ≥65 years who underwent dual-chamber pacemaker implantation at Department of Cardiovascular Medicine, the Third Affiliated Hospital of Soochow University from April 2018 to September 2024. The patients were divided into AHREs group and non-AHREs group based on the presence of AHREs during follow-up. The incidence and risk factors of AHREs were analyzed. Results During a median follow-up of 12 (8,15) months, AHREs occurred in 24 patients (22.4%). The proportion of sick sinus node syndrome (SSS), left atrial volume, percentage of atrial pacing and P-wave sensing amplitude showed significant differences between AHREs group and non-AHREs group (P<0.01).Multivariable logistic regression analysis revealed that SSS (OR=4.065, P=0.015) was an independent risk factor for AHREs, whereas a higher P-wave sensing amplitude (OR=0.372, P<0.01) served as an independent protective factor.Receiver operating characteristic curve analysis showed that the area under the curve of P-wave sensing amplitude in predicting AHREs was 0.834 (P<0.01), with an optimal diagnostic cut-off of 3.85 mV. Conclusions The elderly patients exhibit a high incidence rate of AHREs following dual-chamber pacemaker implantation; SSS and P-wave sensing amplitude are independent predictors of AHREs; A P-wave sensing amplitude ≤3.85 mV is associated with an increased risk of AHREs.

Key words: aged, atrial high-rate episodes, dual-chamber pacemaker, sick sinus node syndrome, P-wave sensing amplitude