Key result
Higher HFA-PEFF score is linked to ~51% higher risk of new-onset sick sinus syndrome.
Why the study?
Although LV diastolic dysfunction frequently coexists with AF, its role in the de novo development of atrial cardiomyopathy phenotypes such as new-onset sick sinus syndrome and AF remains unclear.
Does left ventricular diastolic dysfunction assessed by the HFA-PEFF score predict the development of new-onset sick sinus syndrome and atrial fibrillation in AF-naïve patients undergoing insertable cardiac monitor implantation for unexplained syncope?
Cohort (n=164)
Does left ventricular diastolic dysfunction assessed by the HFA-PEFF score predict the development of new-onset sick sinus syndrome and atrial fibrillation in AF-naïve patients undergoing insertable cardiac monitor implantation for unexplained syncope?
Answers are grounded in this paper and cite their sources.
Left ventricular diastolic dysfunction assessed by the HFA-PEFF score independently predicts new-onset sick sinus syndrome and atrial fibrillation in AF-naïve patients with unexplained syncope, supporting a mechanistic link to early atrial cardiomyopathy.
Background Atrial fibrillation (AF) and sick sinus syndrome (SSS) are increasingly recognized as clinical phenotypes of atrial cardiomyopathy (AtCM). Although left ventricular (LV) diastolic dysfunction frequently coexists with AF, its role in the de novo development of AtCM remains unclear. Purpose To investigate whether LV diastolic dysfunction, assessed by the HFA-PEFF score, is associated with the development of new-onset SSS and AF in patients without prior AF undergoing insertable cardiac monitor (ICM) implantation for unexplained syncope. Methods We retrospectively analyzed 164 patients (median age 71 years, 34% women) who underwent ICM implantation for recurrent unexplained syncope and had no prior AF. LV diastolic dysfunction was assessed using the HFA-PEFF score. Patients were followed for up to 36 months with continuous remote rhythm monitoring. The primary endpoints were new-onset SSS requiring pacemaker implantation and AF episodes lasting ≥6 minutes. Results During a median follow-up of 35 months, SSS occurred in 31 patients (18.9%) and AF ≥6 minutes in 48 patients (29.3%). Patients with high HFA-PEFF scores (5–6) had a significantly higher risk of developing both SSS and AF (Figure 1). The HFA-PEFF score was independently associated with SSS (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.07–2.13; p=0.021) and AF ≥6 minutes (HR 1.94, 95% CI 1.40–2.67; p<0.001) after multivariable adjustment. No significant association was observed between the HFA-PEFF score and atrioventricular block or atrial tachyarrhythmias other than AF. Conclusions LV diastolic dysfunction assessed by the HFA-PEFF score is independently associated with the de novo development of SSS and AF in AF-naïve patients undergoing ICM implantation for unexplained syncope. These findings support a mechanistic link between LV diastolic dysfunction and early atrial cardiomyopathy.
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Sumiyoshi et al. (2026) conducted a cohort in Recurrent unexplained syncope undergoing insertable cardiac monitor implantation (n=164). Left ventricular diastolic dysfunction (HFA-PEFF score) vs. Lower HFA-PEFF score was evaluated on New-onset sick sinus syndrome (SSS) requiring pacemaker implantation and atrial fibrillation (AF) episodes lasting ≥6 minutes (HR 1.51 for SSS; HR 1.94 for AF ≥6 min, 95% CI 1.07-2.13 for SSS; 1.40-2.67 for AF, p=0.021 for SSS; <0.001 for AF). Higher HFA-PEFF score was independently associated with new-onset sick sinus syndrome (HR 1.51; 95% CI 1.07-2.13; P=0.021) and atrial fibrillation ≥6 min (HR 1.94; 95% CI 1.40-2.67; P<0.001).
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