Background: Atrial fibrillation (AF) is the commonest sustained disorder of cardiac rhythm. Permanent pacemaker (PPM)-detected atrial high-rate episodes (AHREs) of even 5-minute duration may identify patients at increased risk for death. Objective: This study aimed to investigate the association of echocardiographic and clinical parameter with the occurrence of AHREs in patients with a dual-chamber pacemaker. Patients and methods: this retrospective study included 208 patients. It was conducted in the Cardiology Department, Faculty of Medicine, Zagazig University Hospitals. The patients were classified according to development of AF into 2 groups: Group (A) involved 77 patients with AF and group < strong> (B) involved 131 patients without AF. Results: The mean age of the studied cases was 61.67 ± 8.13 years and 53.4% were females. Mean SBP was 122.6 ± 16.8 mmHg while mean DBS was 76.9 ± 10.14 mmHg. There was a high statistically significant increase in LA volume index, E/é and a high statistically significant decrease in SV index and EF among AF group compared to non AF group < strong>. Conclusion: In our opinions patients with CIED detected AHREs need oral anticoagulation to prevent thromboembolic events and decrease burden of ischemic stroke.