Atrial high-rate episodes predict clinical outcome in patients with cardiac resynchronization therapy

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Up to 50% of patients receiving cardiac resynchronization therapy (CRT) have pre-existing atrial fibrillation (AF), a condition linked to poorer prognosis.
• The prognostic significance of device-detected atrial high-rate episodes (AHRE), a surrogate for AF, following CRT implantation remains under-evaluated.

Purpose of the Study:

• To investigate the prognostic impact of device-detected AHRE as a predictor of adverse outcomes in patients who have undergone CRT implantation.
• To assess whether new-onset AHRE after CRT correlates with long-term clinical outcomes.

Main Methods:

• Retrospective analysis of consecutive patients who received CRT.
• Evaluation of baseline clinical data and device interrogation data up to 12 months post-implantation.
• Assessment of the composite endpoint of death, heart transplant, or appropriate shock therapy over a median follow-up of 51 months.

Main Results:

• The study included 377 patients; 49% had preoperative AF, associated with worse outcomes.
• A cumulative burden of AHRE at 12 months post-implant independently predicted the primary endpoint.
• AHRE detected within the first year in patients without prior AF did not correlate with worse outcomes.

Conclusions:

• The cumulative burden of AHRE in the first year post-CRT is associated with adverse long-term clinical outcomes in CRT recipients.
• Further prospective trials are warranted to explore rhythm control strategies for patients with CRT and AHRE.