Related Experiment Video
Updated: Nov 19, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Atrial fibrillation burden and heart failure: Data from 39,710 individuals with cardiac implanted electronic devices
Benjamin A Steinberg1, Zhen Li2, Emily C O'Brien3
1Division of Cardiovascular medicine, University of Utah, Salt Lake City, Utah.
Insights
Higher atrial fibrillation burden in patients with cardiac devices is linked to increased risks of heart failure and mortality. This finding highlights the importance of monitoring AF burden for better patient outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Atrial fibrillation (AF) and heart failure (HF) frequently coexist and independently predict poor clinical outcomes.
- The precise relationship between the burden of AF and patient outcomes remains incompletely understood.
Purpose of the Study:
- To investigate the association between device-detected atrial fibrillation burden and clinical outcomes in heart failure patients.
- To quantify the risk of adverse events related to AF burden in patients with and without pre-existing heart failure.
Main Methods:
- Utilized a nationwide remote monitoring database of cardiac implantable electronic devices (CIEDs) linked to Medicare claims.
- Included patients with nonpermanent AF undergoing new CIED implantation, stratified by baseline HF status.
- Assessed outcomes including new-onset HF, HF hospitalization, and all-cause mortality at 1 and 3 years.
Main Results:
- A total of 39,710 patients were analyzed (25,054 with HF, 14,656 without HF).
- In patients without HF, increased AF burden correlated with higher risks of new-onset HF (aHR 1.09 per 10% AF burden) and mortality (aHR 1.05 per 10% AF burden).
- In patients with HF, increased AF burden correlated with higher risks of HF hospitalization (aHR 1.05 per 10% AF burden) and mortality (aHR 1.06 per 10% AF burden).
Conclusions:
- Among older patients with AF receiving a CIED, a greater AF burden is significantly associated with adverse HF outcomes.
- Increased AF burden is also linked to a higher risk of all-cause mortality in this population.
- Device-based AF burden monitoring is crucial for risk stratification and management in patients with or at risk for heart failure.
Background:
Atrial fibrillation (AF) and heart failure (HF) often accompany one another, and each is independently associated with poor outcomes. However, the association between AF burden and outcomes is poorly understood.
Objective:
The purpose of this study was to describe the association between device-based AF burden and HF clinical outcomes.
Methods:
We used a nationwide, remote monitoring database of cardiac implantable electronic devices (CIEDs) linked to Medicare claims. We included patients with nonpermanent AF, undergoing new CIED implant, stratified by baseline HF. The outcomes were new-onset HF, HF hospitalization, and all-cause mortality at 1 and 3 years.
Results:
We identified 39,710 patients who met inclusion criteria (25,054 with HF; 14,656 without HF). Patients with HF were younger (mean age 76.3 vs 78.5 years; P <.001), more often male (65% vs 54%; P <.001), and had higher mean CHA2DS2-VASc scores (5.4 vs 4.1; P <.001). Among those without HF, increasing device-based AF burden was significantly associated with increased risk of new-onset HF (adjusted hazard ratio [HR] 1.09 per 10% AF burden; 95% confidence interval [CI] 1.06-1.12; P <.001) and all-cause mortality (adjusted HR 1.05 per 10% AF burden; 95% CI 1.01-1.10; P = .012). Among patients with HF, increasing AF burden was significantly associated with increased risk of HF hospitalization (adjusted HR 1.05 per 10% AF burden; 95% CI 1.04-1.06; P <.001) and all-cause mortality (adjusted HR 1.06 per 10% AF burden; 95% CI 1.05-1.08; P <.001).
Conclusion:
Among older patients with AF receiving a CIED, increasing AF burden is significantly associated with increasing risk of adverse HF outcomes and all-cause mortality.
More Related Videos
28:13Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
16:40A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:22Heart Failure VI: Adjunct Therapies
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Heart Failure II: Pathophysiology
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:26Heart Failure III: Clinical Manifestations