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Original research
Risk factors and a 3-month risk score for predicting pacemaker implantation in patients with atrial fibrillation
  1. Frederik Dalgaard1,
  2. Jannik Langtved Pallisgaard1,
  3. Tommi Bo Lindhardt1,
  4. Gunnar Gislason1,
  5. Paul Blanche1,
  6. Christian Torp-Pedersen2 and
  7. Martin H Ruwald1
  1. 1Cardiology, Gentofte Hospital, Hellerup, Denmark
  2. 2Health Science and Technology, Aalborg Universitet, Aalborg, Denmark
  1. Correspondence to Frederik Dalgaard; fdalgaard87{at}


Objectives To identify risk factors and to develop a predictive risk score for pacemaker implantation in patients with atrial fibrillation (AF).

Methods Using Danish nationwide registries, patients with newly diagnosed AF from 2000 to 2014 were identified. Cox proportional-hazards regression computed HRs for risk factors of pacemaker implantation. A logistic regression was used to fit a prediction model for 3-month risk of pacemaker implantation and derived a risk score using 80% of the data and its predictive accuracy estimated using the remaining 20%.

Results Among 155 934 AF patients included, the median age (IQR) was 75 (65–83) and 51.3% were men. During a median follow-up time of 3.4 (1.2–5.0) years, 8348 (5.4%) patients received a pacemaker implantation. Risk factors of pacemaker implantation were (in order of highest risk first) age above 60 years, congenital heart disease, heart failure at age under 60 years, prior syncope, valvular AF, hypertension, ischaemic heart disease, male sex and diabetes mellitus. The derived risk score assigns points ranging from 1 to 14 to each of these risk factors. The 3-month risk of pacemaker implantation increased from 0.4% (95% CI: 0.2 to 0.8) at 1 point to 2.6% (95% CI: 1.9 to 3.6) at 18 points. Area under the receiver operator characteristics curve was 62.9 (95% CI: 60.3 to 65.5).

Conclusion We highlighted risk factors of pacemaker implantation in newly diagnosed AF patients and created a risk score. The clinical utility of the risk score needs further investigation.

  • atrial fibrillation
  • pacemaker
  • risk factor
  • risk score
  • prediction
  • heartfailure
  • syncope
  • nationwide
  • cohort study
  • prediction models

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  • Contributors FD, MHR, GG, JLP and PB contributed to the study concept and design; FD and PB conducted the data analysis; FD drafted the manuscript; JLP, TBL, CTP, GG and MHR critically reviewed all drafts of the manuscript.

  • Funding This work was supported by the Danish Heart Foundation (grant number: 16-R107-A6776-22972 and 17-R115-A7443-22062); and FUKAP, research fund of the Department of Cardiology, Herlev and Gentofte Hospital.

  • Competing interests The authors declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: Gunnar Gislason has ownership of stocks in Novo Nordisk Pharmaceuticals and reports research grants from AstraZeneca, Pfizer, Bristol Myers Squibb, Boerhringer Ingelheim and Bayer. Christian Torp-Pedersen declares grants for studies from Bayer. Other authors have no conflict of interest to declare.

  • Patient consent for publication Not required.

  • Ethics approval In Denmark, retrospective register studies do not require approval from the ethics committees. The Danish Data Protection Agency approved this study (Ref no 2007-58-015 I-Suite nr: 02720, GEH-2014–012). Data were made available in an anonymised format such that specific individuals could not be identified.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Due to restrictions related to Danish law and protecting patient privacy, the combined set of data as used in this study can only be made available through a trusted third party, Statistics Denmark. This state organisation holds the data used for this study. Any request on data access should be addressed to Statistics Denmark

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