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January 1, 2023Sunhwan'giOpen Access

Clinical Implications of Device-Detected Atrial Fibrillation in Cardiac Resynchronization Therapy

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Key result

Device-detected atrial fibrillation in heart failure patients treated with cardiac resynchronization therapy was associated with a significantly higher risk of heart failure hospitalization (HR 3.05) and lower rates of optimal biventricular pacing compared to patients without atrial fibrillation.

Why the study?

AF can interfere with adequate biventricular pacing and reduce CRT benefits, but the effect of device-detected AF on clinical outcomes and optimal pacing required investigation.

Does device-detected atrial fibrillation reduce optimal biventricular pacing and worsen clinical outcomes in heart failure patients treated with cardiac resynchronization therapy?

Population

174 patients undergoing CRT implantation at a tertiary center

Comparison

Device-detected AF vs no-AF in patients without preexisting AF

Design

Retrospective cohort study

Follow-up

Median 25.1 months

Authors

MYMinjae YoonJOJaewon OhKCKyeong‐Hyeon Chun

Discussion

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Member takes

Overview

Device-detected AF may warrant closer monitoring in CRT patients; leaves open whether targeted interventions improve pacing and outcomes.

Study Design

Type

Cohort (n=174)

Multicenter

No

Structured PICO

Does device-detected atrial fibrillation reduce optimal biventricular pacing and worsen clinical outcomes in heart failure patients treated with cardiac resynchronization therapy?

P
Population
174 patients with heart failure and reduced ejection fraction who underwent cardiac resynchronization therapy, followed for a median of 25.1 months.
E
Exposure
Device-detected atrial fibrillation (defined as an atrial high-rate episode ≥180 beats per minute lasting more than 6 minutes during follow-up)
C
Comparator
No device-detected atrial fibrillation
O
Outcome
Optimal biventricular (BiV) pacing percentage (defined as ≥98%) and clinical outcomes (heart failure hospitalization, cardiovascular death, and all-cause death)hard clinical

Main Result

Hazard Ratio: 3.05 (95% CI 1.26–7.35)

Absolute Event Rate: 42.1% vs 13.9%

p-value: p=0.013

In heart failure patients receiving cardiac resynchronization therapy, incident device-detected atrial fibrillation significantly reduces the likelihood of achieving optimal biventricular pacing and is associated with worse clinical outcomes.

Limitations

  • Retrospective, single-center study with a small sample size
  • Average percentage of biventricular pacing was derived from the last interrogation, lacking serial data
  • Different CRT device manufacturers used slightly different algorithms for AF detection and CRT optimization
  • Real biventricular pacing rate could be different from the device-reported value because of fusion/pseudofusion beats
  • Could not evaluate the impact of the AF burden on clinical outcomes

Cite This Study

Yoon et al. (2023) conducted a cohort in Heart failure with reduced ejection fraction (n=174). Device-detected atrial fibrillation vs. No atrial fibrillation was evaluated on Heart failure hospitalization (HR 3.05, 95% CI 1.26-7.35, p=0.013). Device-detected atrial fibrillation in heart failure patients treated with cardiac resynchronization therapy was associated with a significantly higher risk of heart failure hospitalization (HR 3.05) and lower rates of optimal biventricular pacing compared to patients without atrial fibrillation.

synapsesocial.com/papers/6a8ada7d3fd21775a5337698https://doi.org/10.4070/kcj.2022.0342
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The Epidemic of Inadequate Biventricular Pacing in Patients With Persistent or Permanent Atrial Fibrillation and Its Association With Mortality2014 · 82 citations
  2. 2Atrioventricular Junction Ablation in Patients with Atrial Fibrillation Treated with Cardiac Resynchronization Therapy: Positive Impact on Ventricular Arrhythmias, Implantable Cardioverter-Defibrillator Therapies and Hospitalizations2017 · 53 citations
  3. 3Cardiac Resynchronization Therapy for Patients With Left Ventricular Systolic Dysfunction2007 · 571 citations
  4. 4Device-detected subclinical atrial tachyarrhythmias: definition, implications and management—an European Heart Rhythm Association (EHRA) consensus document, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE)2017 · 246 citations
  5. 5Subclinical Atrial Fibrillation and the Risk of Stroke2012 · 2,113 citations