Related Experiment Video

Updated: Jul 4, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

Etiology-dependent prognostic impact of atrial fibrillation in implantable cardioverter-defibrillator and cardiac

Taro Temma1, Hisashi Yokoshiki2, Takeshi Mitsuhashi3

  • 1Division of Cardiology, Sakakibara Heart Institute, Fuchu, Japan; Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.

Heart Rhythm
|July 2, 2026
PubMed

Insights

Atrial fibrillation (AF) significantly increases mortality risk in patients with non-ischemic cardiomyopathy (NICM) receiving cardiac devices. However, this association is less pronounced in patients with ischemic cardiomyopathy (ICM).

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Atrial fibrillation (AF) is a common comorbidity in patients with implantable cardiac defibrillators (ICD) or cardiac resynchronization therapy (CRT).
  • Existing evidence on AF's prognostic impact primarily comes from Western cohorts with ischemic cardiomyopathy (ICM), limiting generalizability to populations with higher rates of non-ischemic cardiomyopathy (NICM).
  • Differences in myocardial pathology and remodeling between NICM and ICM suggest AF's prognostic significance may vary by cardiomyopathy etiology.

Purpose of the Study:

  • To investigate whether the prognostic impact of AF differs between NICM and ICM in patients undergoing ICD/CRT implantation.
  • To determine if AF identifies distinct risk profiles based on cardiomyopathy etiology.

Main Methods:

  • Analysis of 4,623 patients from a nationwide cardiac device registry.
  • Outcomes assessed included all-cause death, cardiac death, heart failure hospitalization, and ICD therapies.
  • Multivariable Cox and Fine-Gray competing risk models, propensity score matching (PSM) within ICM and NICM subgroups were employed.

Main Results:

  • AF was linked to higher risks of mortality, cardiac death, and heart failure hospitalization in NICM patients across all models.
  • In contrast, the association between AF and mortality in ICM patients was attenuated and not statistically significant after multivariable adjustment.
  • Post-PSM analysis confirmed that AF remained associated with increased mortality in NICM but not in ICM; AF's impact on ICD therapies did not differ by etiology.

Conclusions:

  • The prognostic significance of AF in ICD/CRT recipients is markedly dependent on the underlying cardiomyopathy etiology.
  • AF identifies a high-risk patient subgroup within NICM, while its impact is diminished in ICM.
  • Etiology-specific risk stratification for AF in cardiac device patients is crucial for effective clinical management.
Abstract

Keywords:
All-cause deathAtrial fibrillationCardiac deathCardiac resynchronization therapyImplantable cardioverter-defibrillatorNon-ischemic cardiomyopathy

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