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. 2021 May;9(10):855.
doi: 10.21037/atm-21-1792.

Association of furosemide or hydrochlorothiazide use with risk of atrial fibrillation post pacemaker implantation among elderly patients

Da-Wei Lin  1 , Feng Jiang  2 , Chen Wu  1 , Yi-Gang Li  1 , Xi Zhang  3 , Yao-Sheng Wang  1   3
Affiliations

Association of furosemide or hydrochlorothiazide use with risk of atrial fibrillation post pacemaker implantation among elderly patients

Da-Wei Lin et al. Ann Transl Med. 2021 May.

Abstract

Background: Atrial fibrillation (AF) induced by artificial pacing is directly related to atrial remodeling. Previous basic research has shown that furosemide aggravates pathologic myocardial remodeling while hydrochlorothiazide alleviates it. However, whether furosemide or hydrochlorothiazide plays a role in developing AF after pacemaker implantation remains unknown. The study aims to investigate the association between oral furosemide or hydrochlorothiazide and the risk of developing AF after pacemaker implantation.

Methods: After a review of electronic medical records, elderly patients with pacemaker implantation and without a known baseline history of AF were included and information on their use of daily oral furosemide or hydrochlorothiazide was extracted. New incident AF cases were confirmed via the records of outpatient visits. A Cox proportional-hazards model was used to evaluate the association between daily oral furosemide or hydrochlorothiazide and risk of developing AF after pacemaker implantation, after adjustment for potential confounders.

Results: Among a total of 551 patients aged more than 65 years, 157 AF cases were identified after pacemaker implantation during a maximum follow up of 3.0±1.6 years. Of these, 242 had used furosemide and 97 had used hydrochlorothiazide therapy. Patients taking daily oral furosemide had a relatively higher risk of AF after pacemaker implantation [hazard ratio (HR): 1.507, 95% confidence interval (CI): 1.036-2.192; P=0.032] after being adjusted for related disease and prescribed medications, while oral taking of hydrochlorothiazide was shown to be a non-effective factor (HR: 0.666, 95% CI: 0.413-1.074), which had no statistical significance.

Conclusions: Daily oral furosemide might increase the risk of developing AF after pacemaker implantation in elderly patients, while hydrochlorothiazide has no detrimental effect.

Keywords: Furosemide; atrial fibrillation (AF); elderly patients; hydrochlorothiazide; pacemaker implantation.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-21-1792). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier curves showing cumulative 72-month atrial fibrillation after pacemaker implantation in the furosemide group.
Figure 2
Figure 2
Kaplan-Meier curves showing cumulative 72-month atrial fibrillation after pacemaker implantation in the hydrochlorothiazide group. HCT, hydrochlorothiazide.
See this image and copyright information in PMC

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