Device-detected atrial tachyarrhythmias predict adverse outcome in real-world patients with implantable biventricular defibrillators
Open accessAbstract
Objectives The purpose of this analysis was to evaluate the correlation between atrial tachycardia (AT) or atrial fibrillation (AF) and clinical outcomes in heart failure (HF) patients implanted with a cardiac resynchronization therapy defibrillator (CRT-D).Background In HF patients, AT and AF have high prevalence and are associated with compromised hemodynamic function.Methods Forty-four Italian cardiological centers followed up 1,193 patients who received a CRT-D according to current guidelines for advanced HF, New York Heart Association functional class ≥ II, left ventricular ejection fraction ≤ 35%, and QRS complex ≥ 120 ms. All patients were in sinus rhythm at implant.Results During a median follow-up period of 13 months, AT/AF >10 min occurred in 361 of 1,193 (30%) patients. The composite end point (deaths or HF hospitalizations) occurred in 174 of 1,193 (14.6%). Multivariate time-dependent Cox regression analyses showed that composite end point risk was higher among patients with device-detected AT/AF (hazard ratio [HR]: 2.16, p = 0.032), New York Heart Association functional class III or IV compared with II (HR: 2.09, p = 0.002), and absence of beta-blockers (HR: 1.36, p = 0.036). Furthermore, the composite end point risk was inversely associated with left ventricular ejection fraction (HR: 1.04, p = 0.045), increasing by a factor of 4% for each 1% decrease in left ventricular ejection fraction.Conclusions In HF patients with CRT-D, device-detected AT/AF is associated with a worse prognosis. Continuous device diagnostics monitoring and Web-based alerts may inform the physician of AT/AF occurrences and identify patients at risk of cardiac deterioration or patients with suboptimal rate or rhythm control. (Italian ClinicalService Project; NCT01007474).
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Strokes often occur without AHRE detected within 30 days before the event.
“Strokes often occur without AHRE detected within 30 days before the event.143-147”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [145]
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- Authors
- Santini, M., Gasparini, M., Landolina, M., Lunati, M., Proclemer, A., Padeletti, L., Catanzariti, D., Molon, G., Botto, G. L., La Rocca, L., Grammatico, A., & Boriani, G.
- Affiliations
- Ospedale San Filippo Neri (IT)
- IRCCS Humanitas Research Hospital (IT)
- Policlinico San Matteo Fondazione (IT)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Ospedale Santa Maria della Misericordia di Udine (IT)
- University of Florence (IT)
- Ospedale Sacro Cuore Don Calabria (IT)
- Ospedale Sant'Anna (IT)
- Medtronic (Italy) (IT)
- University of Bologna (IT)
- Corresponding author
- Santini, Massimo
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2011-01
- Volume
- 57
- Issue
- 2
- Pages
- 167-172
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1998626863
- Cited by
- 121
- References
- 16
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 3 · 2021: 2 · 2020: 9 · 2019: 4 · 2018: 8 · 2017: 9 · 2016: 13 · 2015: 16 · 2014: 15 · 2013: 17 · 2012: 11
- FWCI
- 10.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Florence Research (University of Florence) (submittedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- Funders
- Medtronic
- St. Jude
- Boston Scientific
- Sorin SpA
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- atrial tachyarrhythmia, atrial fibrillation, CRT-D, heart failure, adverse clinical outcomes, mortality, heart failure hospitalization, left ventricular ejection fraction, NYHA functional class, beta-blockers, cardiac implantable electronic devices
- MeSH terms
- Aged, Atrial Fibrillation, Female, Follow-Up Studies, Heart Failure, Humans, Male, Prognosis, Stroke Volume, Tachycardia, Ectopic Atrial, Time Factors, Electrocardiography, Ambulatory, Ventricular Function, Left, Defibrillators, Implantable, Disease Progression
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