Steven Zweibel1,2, Edmond M Cronin1,2, Edward J Schloss3, Angelo Auricchio4, Takashi Kurita5, Laurence D Sterns6, Bart Gerritse7, Daniel R Lexcen8, Alan Cheng8. 1. Division of Electrophysiology, Department of Cardiology, Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut. 2. Division of Cardiology, University of Connecticut School of Medicine, Farmington, Connecticut. 3. Division of Cardiology, The Christ Hospital Physicians-Ohio Heart & Vascular, Cincinnati, Ohio. 4. Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland. 5. Division of Cardiology, Kindai University School of Medicine, Higashi-osaka, Osaka Prefecture, Japan. 6. Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, Canada. 7. Medtronic, Bakken Research Center (BRC), Maastricht, The Netherlands. 8. Medtronic plc, Mounds View, Minnesota.
Abstract
BACKGROUND: Atrial arrhythmias are associated with major adverse cardiovascular events. Recent reports among implantable cardioverter defibrillator (ICD) patients have demonstrated a high prevalence of atrial fibrillation (AF), predominantly in dual-chamber recipients. AF incidence among patients with single-chamber systems (approximately 50% of all ICDs) is currently unknown. The objective was to estimate the prevalence of new-onset AF among single-chamber ICD patients by observing the rates of new atrial tachycardia (AT)/AF among a propensity scoring matched cohort of dual-chamber ICD patients from the PainFree SmartShock technology study, to better inform screening initiatives. METHODS: Among 2770 patients enrolled, 1862 single-chamber, dual-chamber, and cardiac resynchronization therapy subjects with no prior history of atrial tachyarrhythmias were included. Daily AT/AF burden was estimated using a propensity score weighted model against data from dual-chamber ICDs. RESULTS: Over 22 ± 9 months of follow-up, the estimated incidence of AT/AF-lasting at least 6 min, 6 h, and 24 h per day -in the single-chamber cohort was 22.0, 9.8, and 6.3%, whereas among dual-chamber patients, the prevalence was 26.6, 13.1, and 7.1%, respectively. Initiation of oral anticoagulation was estimated to occur in 9.8% of the propensity matched single-chamber cohort, which was higher than the actual observed rate of 6.0%. Stroke and transient ischemic attack occurred at low rates in all device subgroups. CONCLUSIONS: Atrial arrhythmias occur frequently, and significant underutilization of anticoagulation is suggested in single-chamber ICD recipients. Routine screening for AF should be considered among single-chamber ICD recipients.
BACKGROUND:Atrial arrhythmias are associated with major adverse cardiovascular events. Recent reports among implantable cardioverter defibrillator (ICD) patients have demonstrated a high prevalence of atrial fibrillation (AF), predominantly in dual-chamber recipients. AF incidence among patients with single-chamber systems (approximately 50% of all ICDs) is currently unknown. The objective was to estimate the prevalence of new-onset AF among single-chamber ICDpatients by observing the rates of new atrial tachycardia (AT)/AF among a propensity scoring matched cohort of dual-chamber ICDpatients from the PainFree SmartShock technology study, to better inform screening initiatives. METHODS: Among 2770 patients enrolled, 1862 single-chamber, dual-chamber, and cardiac resynchronization therapy subjects with no prior history of atrial tachyarrhythmias were included. Daily AT/AF burden was estimated using a propensity score weighted model against data from dual-chamber ICDs. RESULTS: Over 22 ± 9 months of follow-up, the estimated incidence of AT/AF-lasting at least 6 min, 6 h, and 24 h per day -in the single-chamber cohort was 22.0, 9.8, and 6.3%, whereas among dual-chamber patients, the prevalence was 26.6, 13.1, and 7.1%, respectively. Initiation of oral anticoagulation was estimated to occur in 9.8% of the propensity matched single-chamber cohort, which was higher than the actual observed rate of 6.0%. Stroke and transient ischemic attack occurred at low rates in all device subgroups. CONCLUSIONS:Atrial arrhythmias occur frequently, and significant underutilization of anticoagulation is suggested in single-chamber ICD recipients. Routine screening for AF should be considered among single-chamber ICD recipients.
Authors: Sarah W E Baalman; Suneet Mittal; Lucas V A Boersma; Dave Perschbacher; Amy J Brisben; Deepa Mahajan; Joris R de Groot; Reinoud E Knops Journal: Pacing Clin Electrophysiol Date: 2020-08-07 Impact factor: 1.976