These mechanisms may be strongly associated with the development of AF after pacemaker implantation in the elderly. Conversely, hydrochlorothiazide reduces the serum level of Ang II, thereby inhibiting the transforming growth factor (TGF)-β/Smads signaling pathway to alleviate heart structural pathologic remodeling ( 15). Furosemide enhances plasma renin, angiotensin II (Ang II) and aldosterone, activates sympathetic nerves, and reduces the level of serum magnesium, promoting the development of AF ( 14). However, previous basic research has suggested that these medications may play different roles in the development of AF ( 13). By removing excess liquid from the body, daily oral furosemide and hydrochlorothiazide can help reduce blood pressure, decrease the burden on heart, and alleviate chronic HF. Thiazides, loop diuretics, and potassium-sparing diuretics make up the main composition of diuretics, among which furosemide and hydrochlorothiazide are the most used. Therefore, the potential association between diuretics use and the occurrence of AF after pacemaker implantation in the elderly deserves further investigation. Furthermore, elderly individuals are prone to undergo pacemaker implantation for bradycardia arrhythmias resulting in a higher risk of AF ( 12). In keeping with clinical guidelines, a significant proportion of elderly patients are taking diuretics daily to regulate blood pressure, reduce the burden on the heart, and eliminate edema to counter the impacts caused by hypertension (HTN), heart failure (HF), abnormal renal and liver function, and other diseases ( 10, 11). While much attention has recently been paid to the effects of commonly used cardiovascular drugs, such as ACEI, ARB, and statins in the occurrence of AF in patients implanted with a permanent pacemaker, few studies have focused on the effect of diuretics ( 8, 9). In addition, sympathetic activation, inflammation, and pacing mode are associated with the risk of developing AF after pacemaker implantation ( 6, 7). AF induced by artificial pacing is widely considered to be directly related to atrial pathologic remodeling, which includes structural pathologic remodeling and electrical remodeling. However, a significant amount of research including the MOST study and CTOPP study has shown that the incidence of atrial fibrillation (AF) in pacemaker implanted populations increases from 3% to 15–30% ( 3- 5). Pacemaker implantation is currently a common and effective method to treat many types of bradycardia arrhythmias ( 1, 2).

Atrial fibrillation fluid retention