Undiagnosed paroxysmal AF in heart failure patients with CRT devices showed a non-significant trend toward increased mortality compared to persistent sinus rhythm (19.2% vs 10.4%; P=NS).
Cohort (n=162)
Is asymptomatic paroxysmal atrial fibrillation detected by CRT devices associated with adverse outcomes in patients with chronic heart failure?
A significant proportion of heart failure patients with CRT devices perceived to be in sinus rhythm have undiagnosed paroxysmal atrial fibrillation, though it was not significantly associated with increased adverse outcomes in this cohort.
Absolute Event Rate: 19.2% vs 10.4%
p-value: p=NS
AIMS: Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with chronic heart failure (CHF). Under-detection of asymptomatic paroxysmal AF (PAF) underestimates the true burden of AF in patients with CHF. We retrospectively studied the prevalence of asymptomatic PAF in 162 CHF patients through analysis of cardiac resynchronization therapy (CRT) device downloads to determine whether these episodes are associated with adverse outcomes. METHODS AND RESULTS: An episode of AF was defined by mode switching on CRT devices with an atrial rate >200 for at least 30 s. Of the 101 patients thought to be persistently in sinus rhythm (SR), 27% were found to have significant paroxysms of AF, with the cumulative percentage of time in the 'mode-switch mode' (i.e. the AF burden) of 1.6 +/- 0.9%. Mortality was 19.2% in patients with newly identified PAF with hospitalization and thrombo-embolism rates of 42.3 and 2.1%, respectively, compared with mortality of 10.4% with hospitalization and thrombo-embolism rates of 41.8 and 1.9%, respectively, in patients persistently in SR (P= NS). CONCLUSION: Analysis of data from CRT devices in a population of CHF patients with severe left ventricular dysfunction shows that a significant proportion of those perceived to be persistently in SR have undiagnosed paroxysms of AF but with relatively low burden. These episodes appear to be associated with a trend towards increased mortality but no effects on hospitalization or thrombo-embolism rates.
Caldwell et al. (Sat,) conducted a cohort in chronic heart failure (n=162). Newly identified paroxysmal atrial fibrillation vs. Persistent sinus rhythm was evaluated on Mortality (p=NS). Undiagnosed paroxysmal AF in heart failure patients with CRT devices showed a non-significant trend toward increased mortality compared to persistent sinus rhythm (19.2% vs 10.4%; P=NS).