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Abstract Background Atrial pacing (AP) can unmask or aggravate a preexisting interatrial block (IAB). The aim of our study was to determine whether AP is associated with the development of atrial high‐rate episodes (AHRE) during follow‐up. Methods Patients with dual‐chamber cardiac implantable electronic devices (CIEDs), no previous documented atrial fibrillation, and with a 6‐month minimum follow‐up were included. In all patients, sinus and paced P‐wave duration were measured. AHRE was defined as an episode of atrial rate ≥225 bpm with a minimum duration of 5 min, excluding those documented during the first 3 months after implantation. Results A total of 220 patients were included (75 ± 10 years, 61% male). After a mean follow‐up of 59 ± 25 months, 46% of patients presented AHRE. Mean paced P‐wave duration was significantly longer than the sinus P‐wave duration (154 ± 27 vs. 115 ± 18 ms; p < .001). Sinus and paced P‐waves were significantly longer in those who developed AHRE (sinus: 119 ± 20 vs. 112 ± 16; p = .006; paced: 161 ± 29 vs. 148 ± 23; p < .001). A paced P‐wave ≥160 ms was the best predictor of AHRE, especially those lasting >24 h (odds ratio [OR] 4.2 [95% confidence interval (CI)] [1.6–11.4]; p = .004). Conclusions AP significantly prolongs P‐wave duration and is associated with further development of AHRE. A paced P‐wave ≥160 ms is a strong predictor of AHRE and should be taken into consideration as a new definition of IAB in the presence of AP.

Paced P‐wave duration as a significant predictor for atrial high‐rate episodes in patients with cardiac implantable electronic devices

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