August 13, 2019BMC Cardiovascular DisordersOpen Access

Atrial fibrillation incidence and impact of biventricular pacing on long-term outcome in patients with heart failure treated with cardiac resynchronization therapy

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=379). Intervention: Atrial fibrillation history and biventricular pacing ≤98% vs. No atrial fibrillation. Primary outcome: Death from any cause or heart transplantation (HR 1.9, 95% CI 1.2-3.0, p=0.005).

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Key result

In CRT recipients, a history of atrial fibrillation combined with biventricular pacing ≤98% during the first year was associated with a higher risk of death or heart transplantation compared to patients without atrial fibrillation (HR 1.9).

Why the study?

In patients treated with CRT, AF is linked to unfavorable outcomes and can reduce biventricular pacing, an established determinant of CRT success.

Does achieving >98% biventricular pacing improve long-term survival in heart failure patients with atrial fibrillation treated with cardiac resynchronization therapy?

Population

379 heart failure patients treated with CRT at a Swedish tertiary referral center

Comparison

AF history and BivP <=98% vs BivP >98% vs no AF

Design

Retrospective cohort study

Follow-up

10-years

Authors

JJJonatan Jacobsson CRChristian Reitan JCJonas Carlson

Discussion

Member takes

Overview

BivP ≤98% was associated with higher death/HTx risk in AF patients; leaves open whether attaining >98% improves outcomes in prospective trials.

Study Design

Type

Cohort (n=379)

Multicenter

Structured PICO

Does achieving >98% biventricular pacing improve long-term survival in heart failure patients with atrial fibrillation treated with cardiac resynchronization therapy?

Population

379 patients (median age 71, 15% female) with heart failure treated with cardiac resynchronization therapy, followed for 10 years.

Exposure

Biventricular pacing (BivP) ≤98% during the first year of CRT treatment in patients with a history of atrial fibrillation.

Comparator

Biventricular pacing >98% during the first year of CRT treatment, and/or patients without a history of atrial fibrillation.

Outcome

Combined endpoint of death from any cause or heart transplantation at 10 years of follow-up.hard clinical

Main Result

Hazard Ratio: 1.9 (95% CI 1.2–3)

p-value: p=0.005

In heart failure patients receiving CRT, a history of atrial fibrillation combined with biventricular pacing ≤98% independently predicts poor long-term outcomes, emphasizing the critical need to achieve >98% biventricular pacing to maximize CRT benefits.

Limitations

Retrospective design
No intra-cardiac electrograms were studied
No standardized way to keep physicians' record of device-stored data
Some atrial high-rate episodes might not reflect true episodes of atrial fibrillation
Only 254 of 379 patients had enough available data to be included in the analyses regarding the prognostic impact of biventricular pacing
Patient-physician preferences might have influenced treatment decisions causing a non-homogenous group
No intra-cardiac electrograms were studied.
No standardized way to keep the physicians' record of device-stored data.
Possible that some atrial high-rate episodes (AHREs) do not reflect true episodes of AF.
Only 254 of all 379 patients had enough available data to be included in the analyses regarding the prognostic impact of BivP.
Patient-physician preferences might have influenced decisions causing a non-homogenous group of patients.

Cite This Study

Jacobsson et al. (2019) conducted a cohort in Heart failure (n=379). Atrial fibrillation history and biventricular pacing ≤98% vs. No atrial fibrillation was evaluated on Death from any cause or heart transplantation (HR 1.9, 95% CI 1.2-3.0, p=0.005). In CRT recipients, a history of atrial fibrillation combined with biventricular pacing ≤98% during the first year was associated with a higher risk of death or heart transplantation compared to patients without atrial fibrillation (HR 1.9).

synapsesocial.com/papers/6a9d56547813c4196b46d4e8 https://doi.org/10.1186/s12872-019-1169-1

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August 13, 2019BMC Cardiovascular DisordersOpen Access

Atrial fibrillation incidence and impact of biventricular pacing on long-term outcome in patients with heart failure treated with cardiac resynchronization therapy

View Full Paper

Ask AI

Bookmark

Key result

Why the study?

In patients treated with CRT, AF is linked to unfavorable outcomes and can reduce biventricular pacing, an established determinant of CRT success.

Does achieving >98% biventricular pacing improve long-term survival in heart failure patients with atrial fibrillation treated with cardiac resynchronization therapy?

Population

379 heart failure patients treated with CRT at a Swedish tertiary referral center

Comparison

AF history and BivP <=98% vs BivP >98% vs no AF

Design

Retrospective cohort study

Follow-up

10-years

Authors

JJJonatan Jacobsson CRChristian Reitan JCJonas Carlson

Discussion

Member takes

Overview

BivP ≤98% was associated with higher death/HTx risk in AF patients; leaves open whether attaining >98% improves outcomes in prospective trials.

Study Design

Type

Cohort (n=379)

Multicenter

Structured PICO

Does achieving >98% biventricular pacing improve long-term survival in heart failure patients with atrial fibrillation treated with cardiac resynchronization therapy?

Population

379 patients (median age 71, 15% female) with heart failure treated with cardiac resynchronization therapy, followed for 10 years.

Exposure

Biventricular pacing (BivP) ≤98% during the first year of CRT treatment in patients with a history of atrial fibrillation.

Comparator

Biventricular pacing >98% during the first year of CRT treatment, and/or patients without a history of atrial fibrillation.

Outcome

Combined endpoint of death from any cause or heart transplantation at 10 years of follow-up.hard clinical

Main Result

Hazard Ratio: 1.9 (95% CI 1.2–3)

p-value: p=0.005

Limitations

Retrospective design
No intra-cardiac electrograms were studied
No standardized way to keep physicians' record of device-stored data
Some atrial high-rate episodes might not reflect true episodes of atrial fibrillation
Only 254 of 379 patients had enough available data to be included in the analyses regarding the prognostic impact of biventricular pacing
Patient-physician preferences might have influenced treatment decisions causing a non-homogenous group
No intra-cardiac electrograms were studied.
No standardized way to keep the physicians' record of device-stored data.
Possible that some atrial high-rate episodes (AHREs) do not reflect true episodes of AF.
Only 254 of all 379 patients had enough available data to be included in the analyses regarding the prognostic impact of BivP.
Patient-physician preferences might have influenced decisions causing a non-homogenous group of patients.

Cite This Study

synapsesocial.com/papers/6a9d56547813c4196b46d4e8 https://doi.org/10.1186/s12872-019-1169-1

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