Key result
The onset of persistent atrial tachyarrhythmias or atrial fibrillation was associated with a significantly higher probability of thoracic fluid accumulation in the first month (HR 1.65; 95% CI 1.58-1.72; P<0.001).
Why the study?
Does the onset of persistent atrial tachyarrhythmias precede thoracic fluid accumulation in patients with implantable devices?
Cohort (n=73,018)
Does the onset of persistent atrial tachyarrhythmias precede thoracic fluid accumulation in patients with implantable devices?
The onset of persistent atrial tachyarrhythmias temporally precedes thoracic fluid accumulation in patients with implantable devices, highlighting a bidirectional relationship between AF and heart failure exacerbation.
May prompt closer fluid monitoring after persistent atrial tachyarrhythmia onset in device patients; leaves open causal links and need for prospective trials.
BACKGROUND: The complex relationship between heart failure and atrial tachyarrhythmias (AT/atrial fibrillation [AF]) is not well understood. We examined the temporal association between changes in intrathoracic impedance, suggesting thoracic fluid accumulation, and AT/AF occurrence in cardiac resynchronization therapy-defibrillator and implantable cardioverter defibrillator (ICD) patients. METHODS: A retrospective analysis was conducted on stored implantable device data to identify patients with automatic monitoring of daily AT/AF burden and intrathoracic impedance. Daily population trends in AT/AF burden before and after a fluid index threshold crossing (FIC) were determined. RESULTS: A total of 73,018 patients (68 ± 12 years, 51% ICD, 75% male) were evaluated over 18.6 ± 11.5 months. Kaplan-Meier analysis indicated a significantly higher probability of FIC events in the first month following the onset of persistent AT/AF when compared to a matched group without persistent AT/AF (hazard ratio [HR] 1.65, 95% confidence interval [CI] [1.58, 1.72], P < 0.001). Conversely, patients were significantly more likely to experience an episode of persistent AF in the first month after the FIC event (HR 1.32, 95% CI [1.08, 1.63], P = 0.008). The probability of a fluid index crossing within 30 days of the onset of persistent AT/AF was significantly lower in a subgroup of patients with adequate rate control (35.8% [34.3-37.4%] vs 42.0% [39.6-44.6%]; HR 1.24 [1.13-1.36]). CONCLUSION: Thoracic fluid accumulation, as indicated by decreasing intrathoracic impedance, was more likely to occur immediately after the onset of persistent AT/AF, especially in the presence of inadequate rate control. Likewise, the onset of persistent AT/AF was more likely following a decrease in intrathoracic impedance.
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Andriulli et al. (2013) conducted a cohort in Heart failure and atrial tachyarrhythmias in implantable device patients (n=73,018). Onset of persistent AT/AF vs. Matched group without persistent AT/AF was evaluated on Fluid index threshold crossing (FIC) events in the first month following the onset of persistent AT/AF (HR 1.65, 95% CI 1.58-1.72, p=<0.001). The onset of persistent atrial tachyarrhythmias or atrial fibrillation was associated with a significantly higher probability of thoracic fluid accumulation in the first month (HR 1.65; 95% CI 1.58-1.72; P<0.001).
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