Pacemaker implantation is common in patients with AF, yet its impact on long-term cardiovascular outcomes has remained uncertain. A large Swiss cohort study published in EP Europace offers new insights into this association.

Data from the Swiss-AF and Beat-AF studies included 3,675 patients followed annually for up to eight years. The median age was 71 years, and 28.8% were women. At baseline, 12.1% of participants had pacemakers, while 7.4% received them during follow-up.

Major adverse cardiovascular events (MACE) included stroke, transient ischemic attack, myocardial infarction, cardiovascular death, and systemic embolism. Event rates for MACE and heart failure hospitalization were higher in patients with pacemakers (5.97 and 5.08 per 100 patient-years, respectively) compared with those without devices (3.37 and 2.61 per 100 patient-years).

After multivariable adjustment, pacemaker implantation was not independently associated with MACE (adjusted hazard ratio [95% confidence interval], 1.12 [0.95–1.33]; P = 0.183) or heart failure (1.14 [0.94–1.37]; P = 0.180).

These findings indicate that higher event rates among AF patients with pacemakers likely reflect comorbid disease burden rather than the device itself. The results highlight the importance of ongoing cardiovascular risk assessment and individualized follow-up in this patient population.