Relationship between device-detected subclinical atrial fibrillation and heart failure in patients with cardiac
Shuhei Arai1, Mitsuharu Kawamura1, Toshihiko Gokan1
1Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
Insights
Subclinical atrial fibrillation (AF) detected after cardiac resynchronization therapy defibrillator (CRT-D) implantation significantly increases heart failure (HF) hospitalization risk. This highlights the need for proactive monitoring and management of subclinical AF in HF patients.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Atrial fibrillation (AF) is a primary preventable cause of heart failure (HF).
- Early detection and treatment of AF are crucial for managing HF.
- Subclinical AF often remains undetected in patients receiving cardiac resynchronization therapy defibrillator (CRT-D) devices.
Purpose of the Study:
- To investigate the association between subclinical AF and heart failure (HF) hospitalization.
- To determine if subclinical AF increases the risk of inappropriate device therapy.
- To evaluate the impact of subclinical AF on HF outcomes in CRT-D patients.
Main Methods:
- A cohort of 153 patients with ejection fraction <35% was studied.
- Patients were categorized into three groups: subclinical AF (n=30), clinical AF (n=45), and no AF (n=78).
- Baseline characteristics, HF hospitalizations, and device therapies were compared over a 50-month follow-up period.
Main Results:
- Subclinical AF was associated with significantly higher rates of inappropriate therapy (13%) and lower biventricular pacing (81%) compared to other groups.
- Kaplan-Meier analysis revealed a significantly higher HF hospitalization rate in the subclinical AF group (70%) versus clinical AF (49%) and no AF (38%) groups (P=.03).
- Multivariable analysis identified subclinical AF as an independent predictor of HF hospitalization.
Conclusions:
- Subclinical AF following CRT-D implantation is linked to a substantially elevated risk of HF hospitalization.
- Potential contributing factors include loss of effective biventricular pacing and increased inappropriate device therapy.
- These findings underscore the importance of monitoring for and managing subclinical AF in patients with CRT-D devices.
Background:
Atrial fibrillation (AF) is a leading preventable cause of heart failure (HF) for which early detection and treatment is critical. Subclinical-AF is likely to go untreated in the routine care of patients with cardiac resynchronization therapy defibrillator (CRT-D).
Hypothesis:
The hypothesis of our study is that subclinical-AF is associated with HF hospitalization and increasing an inappropriate therapy.
Methods:
We investigated 153 patients with an ejection fraction less than 35%. We divided into three groups, subclinical-AF (n = 30), clinical-AF (n = 45) and no-AF (n = 78). We compared the baseline characteristics, HF hospitalization, and device therapy among three groups. The follow-up period was 50 months after classification of the groups.
Results:
The average age was 66 ± 15 years and the average ejection fraction was 26 ± 8%. Inappropriate therapy and biventricular pacing were significantly different between subclinical-AF and other groups (inappropriate therapy: subclinical-AF 13% vs clinical-AF 8.9% vs no-AF 7.7%: P = .04, biventricular pacing: subclinical-AF 81% vs clinical-AF 85% vs no-AF 94%, P = .001). Using Kaplan-Meier method, subclinical-AF group had a significantly higher HF hospitalization rate as compared with other groups. (subclinical-AF 70% vs clinical-AF 49% vs no-AF 38%, log-rank: P = .03). In multivariable analysis, subclinical-AF was a predictor of HF hospitalization.
Conclusions:
Subclinical-AF after CRT-D implantation was associated with a significantly increased risk of HF hospitalization. The loss of the biventricular pacing and increasing an inappropriate therapy might affect the risk of HF hospitalization.
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