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Published on: February 28, 2012
Can we predict new AF occurrence in single-chamber ICD patients? Insights from an observational investigation
Mauro Biffi1, Matteo Ziacchi1, Renato Pietro Ricci2
1Policlinico S. Orsola - Malpighi, Bologna, Italy.
Insights
Atrial tachyarrhythmias (AT/AF) occurred in 37.4% of dual-chamber ICD patients without pacing needs. The CHADS₂ score predicts new-onset AT/AF in these patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrial tachyarrhythmias (AT/AF) increase risks of mortality, morbidity, and stroke.
- Single-chamber ICDs cannot detect AT/AF, leaving its incidence unknown in these patients.
Purpose of the Study:
- To determine AT/AF incidence in dual-chamber ICD patients without pacing indications or prior AT/AF.
- To identify predictors of new-onset AT/AF in this specific patient group.
Main Methods:
- Prospective observational study across 47 Italian centers.
- Reviewed clinical and device data of 428 dual-chamber ICD patients.
- Multivariate regression analyzed AT/AF risk factors, including CHADS₂ score.
Main Results:
- AT/AF episodes (≥5 min) occurred in 37.4% of patients over a median 31-month follow-up.
- Higher AT/AF incidence (≥6h) observed in patients with CHADS₂ score ≥2 (HR=1.69).
- CHADS₂ score emerged as a significant predictor of AT/AF.
Conclusions:
- AT/AF is common in dual-chamber ICD patients mimicking single-chamber recipients.
- CHADS₂ score is a valuable predictor for new-onset AT/AF in this population.
Background:
Atrial tachyarrhythmias (AT/AF) have been associated with an increased risk of mortality, morbidity and ischemic stroke. Up to now, single chamber ICD diagnostics was not able to detect AT/AF, therefore the incidence of new onset AT/AF in patients with single chamber ICD is not known.
Objective:
To evaluate incidence and predictors of AT/AF occurrence in patients with dual-chamber ICD with no pacing indications and no history of AT/AF that strictly mimic single chamber ICD recipient.
Methods & Results:
Consecutive dual-chamber ICD patients were prospectively followed by 47 Italian cardiologic centers in an observational research. Clinical and device data were reviewed by expert cardiologists to assess AT/AF occurrence. Multivariate regression analysis evaluated the risk of new-onset AT/AF and its association with patients' baseline characteristics and with CHADS2 score. 428 (13.4% female, 64years old) patients were followed for a median observation period of 31months. AT/AF episodes occurred in 160 (37.4%) patients when considering at least 5min duration, in 95 (22.2%) for AT/AF ≥6h, in 47 (11.0%) for AT/AF ≥1day, in 29 (6.8%) for AT/AF ≥7days. Patients with CHADS2≥2, who comprised 36% of the whole population, showed higher incidence of AT/AF ≥6h compared with patients with CHADS2<2 (Hazard Ratio=1.69, 95% Confidence Interval=1.13-2.53, p=0.011).
Conclusions:
Our observations in a population of dual-chamber ICD patients with no pacing indications and no history of AT/AF, who strictly mimic single-chamber ICD recipients, highlight that AT/AF episodes occurred in the 37.5% of the population and CHADS2 score is predictive of new-onset AT/AF.
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