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Published on: February 26, 2013
Predictors of new onset atrial fibrillation in patients with heart failure
Niall G Campbell1, Emily J Cantor1, Vinit Sawhney1
1Cardiology Research Department, St Bartholomew's Hospital, Queen Mary University of London, United Kingdom.
Insights
Renal impairment (RI) in heart failure patients with implantable cardiac defibrillators (ICDs) predicts future atrial fibrillation (AF) and mortality. Regular screening for asymptomatic AF is crucial in these patients.
Area of Science:
- Cardiology
- Nephrology
- Electrophysiology
Background:
- Atrial fibrillation (AF) increases stroke risk in heart failure patients.
- Predictors of AF development and evolution in heart failure remain unclear.
- Implantable cardiac defibrillators (ICDs) offer optimal AF detection.
Purpose of the Study:
- To identify variables predicting future AF in heart failure patients with ICDs.
- To investigate the evolution of AF over time in this cohort.
Main Methods:
- Retrospective observational cohort study of 197 ischemic cardiomyopathy patients with primary prevention ICDs.
- Patients with no prior AF history at implant were included.
- Multivariable logistic regression analyzed nine baseline variables for AF prediction (AF defined as atrial tachyarrhythmia ≥180 bpm and ≥30 s).
Main Results:
- 44.2% of patients developed AF after a median follow-up of 2.8 years.
- Renal impairment (RI) was the sole independent predictor of future AF (HR: 2.04).
- RI and non-white ethnicity independently predicted all-cause mortality.
Conclusions:
- Renal impairment at ICD implant is an independent predictor of both future AF and long-term all-cause mortality.
- RI is a stronger predictor of AF than age in this population.
- Regular screening for asymptomatic AF is recommended for heart failure patients with RI to guide stroke prophylaxis.
Introduction:
Stroke associated with atrial fibrillation (AF) is more frequent in heart failure. It is unknown what variables predict future AF in these patients and how AF might evolve over time. We investigated this in patients with implantable cardiac defibrillators (ICD) where AF detection is optimal.
Methods:
Single centre, retrospective, observational cohort study. All ischaemic cardiomyopathy patients with dual chamber, primary prevention ICD implants between Aug 2003 and Dec 2009 were screened and included if at implant, they had no known AF history. Nine variables were analysed. AF was defined as any atrial tachyarrhythmia ≥180 bpm and ≥30 s. Multivariable, binary logistic regression models were built by adding variables significant in the univariate models. Variables were retained in the final multivariate models if p<0.05.
Results:
n=197 met the inclusion criteria (85.8% male, median age: 66.8 years). After median follow-up for 2.8 years, 44.2% developed AF. After univariate analysis, the baseline variables associated with AF after implant were age, NYHA class and renal impairment (RI, defined eGFR<60 ml/min/1.73 m2) (p<0.05). After multivariable analysis, the only variable which was associated with AF was RI (HR: 2.04 (CI: 1.10-3.79)). Two baseline variables were independently associated with all-cause mortality: RI (HR: 2.42 (1.14-5.12)) and non-white ethnicity.
Conclusion:
RI at time of implant was independently associated with both future AF and all-cause mortality during long-term follow-up. RI was a stronger predictor of AF than age. Those patients with heart failure and RI should be regularly screened for asymptomatic AF, regardless of age, to ensure that stroke prophylaxis may be initiated.
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