BACKGROUND:Atrial fibrillation (AF) has been associated with higher rates of all-cause mortality in patients with heart failure (HF). The risk of newly detected AF in patients receiving implantable cardioverter-defibrillator (ICD) therapy is unknown. METHODS: Newly detected AF was evaluated in all patients enrolled in the Inhibition of Unnecessary RV Pacing with AV Search Hysteresis in ICDs (INTRINSIC RV) study. The relationships between AF and endpoints (total mortality, ICD shocks, and HF hospitalizations) were analyzed retrospectively with proportional-hazards models. RESULTS:At 108 centers, 1530 patients meeting VITALITY AVT ICD indications were followed for 12 months. Of these, 1356 (89%) had no history of AF at the time of implant. Patients with a history of AF had a higher prevalence of HF (52% vs. 36%; P <.01) and had higher rates of HF hospitalization (hazard ratio [HR] 2.14 [1.29-3.54], P <.01), death (HR 2.22 [1.26-3.92], P <.01), and any ICD shock (HR 1.75 [1.19-2.58], P <.01) compared with those with no history. AF incidence during the first 3 months of implant was available in 1317 (86%; 1170 no AF, 147 history of AF) patients. New-onset AF during the first 3 months of implant (45 of 1170, 4%) was associated with a significant increased risk of death (HR 2.86 [1.02-8.05], P = .05) but not with inappropriate ICD shock (HR 2.43 [0.87-6.75], P = .09) or HF hospitalization (HR 1.17 [0.28-4.82], P = .83). CONCLUSION: History of AF at the time of ICD implant identifies additional risk of HF and death. Newly detected AF is associated with significantly higher rates of death. The relationship between newly detected AF and inappropriate ICD shock or HF hospitalization is uncertain and requires further study.
RCT Entities:
BACKGROUND:Atrial fibrillation (AF) has been associated with higher rates of all-cause mortality in patients with heart failure (HF). The risk of newly detected AF in patients receiving implantable cardioverter-defibrillator (ICD) therapy is unknown. METHODS: Newly detected AF was evaluated in all patients enrolled in the Inhibition of Unnecessary RV Pacing with AV Search Hysteresis in ICDs (INTRINSIC RV) study. The relationships between AF and endpoints (total mortality, ICD shocks, and HF hospitalizations) were analyzed retrospectively with proportional-hazards models. RESULTS: At 108 centers, 1530 patients meeting VITALITY AVT ICD indications were followed for 12 months. Of these, 1356 (89%) had no history of AF at the time of implant. Patients with a history of AF had a higher prevalence of HF (52% vs. 36%; P <.01) and had higher rates of HF hospitalization (hazard ratio [HR] 2.14 [1.29-3.54], P <.01), death (HR 2.22 [1.26-3.92], P <.01), and any ICD shock (HR 1.75 [1.19-2.58], P <.01) compared with those with no history. AF incidence during the first 3 months of implant was available in 1317 (86%; 1170 no AF, 147 history of AF) patients. New-onset AF during the first 3 months of implant (45 of 1170, 4%) was associated with a significant increased risk of death (HR 2.86 [1.02-8.05], P = .05) but not with inappropriate ICD shock (HR 2.43 [0.87-6.75], P = .09) or HF hospitalization (HR 1.17 [0.28-4.82], P = .83). CONCLUSION: History of AF at the time of ICD implant identifies additional risk of HF and death. Newly detected AF is associated with significantly higher rates of death. The relationship between newly detected AF and inappropriate ICD shock or HF hospitalization is uncertain and requires further study.
Authors: Aneta Aleksova; Marco Merlo; Massimo Zecchin; Gastone Sabbadini; Giulia Barbati; Giancarlo Vitrella; Andrea Di Lenarda; Gianfranco Sinagra Journal: Clin Med Res Date: 2010-08-03
Authors: Chirag M Sandesara; Renee M Sullivan; Andrea M Russo; WeiWei Li; Arthur Kendig; John D Day; Christopher Mullin; Kira Stolen; Brian Olshansky Journal: J Cardiovasc Transl Res Date: 2010-11-18 Impact factor: 4.132