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Published on: December 11, 2017
Atrial fibrillation in cardiac resynchronization therapy with a defibrillator: a risk factor for mortality,
Nick van Boven1, Dominic Theuns, Kjell Bogaard
1Department of Cardiology, Medical Centre Alkmaar (MCA), Alkmaar, The Netherlands.
Insights
Atrial fibrillation history predicts mortality and shocks in cardiac resynchronization therapy with a defibrillator (CRT-D) patients. Managing AF is key to improving outcomes for those with CRT-D devices.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Predictive factors for mortality and shocks in CRT-D are crucial for patient outcomes.
- Updated knowledge is needed to refine clinical predictions in CRT-D therapy.
Purpose of the Study:
- To identify risk factors for all-cause mortality.
- To assess predictors of appropriate and inappropriate shocks in CRT-D patients.
Main Methods:
- Retrospective analysis of 543 consecutive patients receiving CRT-D.
- Multivariable Cox regression was used to analyze outcomes.
Main Results:
- Atrial fibrillation (AF) history, higher creatinine, and lower LVEF predicted mortality.
- AF history predicted appropriate and inappropriate shocks across patient groups.
- Appropriate shocks increased mortality risk, while inappropriate shocks did not.
Conclusions:
- History of AF is an independent risk factor for mortality and shocks in CRT-D patients.
- Optimizing AF management is vital for improving care in CRT-D recipients.
Introduction:
Knowledge about predictive factors for mortality and (in)appropriate shocks in cardiac resynchronization therapy with a defibrillator (CRT-D) should be available and updated to predict clinical outcome.
Methods:
We retrospectively analyzed 543 consecutive patients assigned to CRT-D in 2 tertiary medical centers. The aim of this study was to assess risk factors for all-cause mortality, appropriate and inappropriate shocks.
Results:
Mean follow-up time was 3.2 (±1.8) years. A total of 110 (20%) patients died, 71 (13%) received ≥1 appropriate shocks, and 33 (6.1%) received ≥1 inappropriate shocks. No patients received a His bundle ablation and biventricular pacing percentage was not analyzed. Multivariable Cox regression analysis showed that a history of atrial fibrillation (AF) (HR 1.74 CI 1.06-2.86), higher creatinine (HR 1.12; CI 1.08-1.16), and a poorer left ventricular ejection fraction (LVEF) (HR 0.97; CI 0.94-1.01) independently predict all-cause mortality. In the entire cohort, history of AF and secondary prevention were independent predictors of appropriate shocks and variables associated with inappropriate shocks were history of AF and QRS ≥150 milliseconds. In primary prevention patients, history of AF also predicted appropriate shocks as did ischemic cardiomyopathy and poorer LVEF. History of AF, QRS ≥150 milliseconds, and lower creatinine were associated with inappropriate shocks in this subgroup. Appropriate shocks increased mortality risk, but inappropriate shocks did not.
Conclusion:
In symptomatic CHF patients treated with CRT-D, history of AF is an independent risk factor not only for mortality, but also for appropriate and inappropriate shocks. Further efforts in AF management may optimize the care in CRT-D patients.
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