Pasquale Vergara1, Francesco Solimene2, Antonio D'Onofrio3, Ennio C Pisanò4, Gabriele Zanotto5, Carlo Pignalberi6, Saverio Iacopino7, Giampiero Maglia8, Paolo Della Bella9, Valeria Calvi10, Antonio Curnis11, Gaetano Senatore12, Mauro Biffi13, Alessandro Capucci14, Quintino Parisi15, Fabio Quartieri16, Fabrizio Caravati17, Massimo Giammaria18, Massimiliano Marini19, Antonio Rapacciuolo20, Michele Manzo21, Daniele Giacopelli22, Alessio Gargaro22, Renato P Ricci23. 1. Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy. Electronic address: pasqualevergara@hotmail.com. 2. Electrophysiology Lab, Clinica Montevergine, Mercogliano (AV), Italy. 3. Electrophysiology and Cardiac, Pacing Unit, Ospedale Monaldi, Naples, Italy. 4. Cardiology, Department, Ospedale Vito Fazzi, Lecce, Italy. 5. Cardiology Department, Ospedale Mater Salutis, Legnago, Italy. 6. Cardiology Department, Ospedale San Filippo Neri, Rome, Italy. 7. Arrhythmias and Cardiac Electrophysiology, Villa Maria Care & Research, Cotignola (RA), Italy. 8. Electrophysiology, Cardiac Pacing, and Arrhythmias, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy. 9. Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy. 10. Electrophysiology and Cardiac Pacing, Policlinico Vittorio Emanuele PO Ferrarotto, Catania, Italy. 11. Cardiology Division, Spedali Civili, Brescia, Italy. 12. Cardiology Division, Ospedale di Ciriè, Ciriè (TO), Italy. 13. Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico Sant'Orsola-Malpighi, Bologna, Italy. 14. Cardiology Department, Ospedali Riuniti, Ancona, Italy. 15. Cardiology Department, Fondazione di Ricerca e Cura Giovanni Paolo II, Campobasso, Italy. 16. Department of Interventional Cardiology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. 17. Department of Cardiology I, Ospedale di Circolo e Fond. Macchi, Varese, Italy. 18. Department of Cardiology, Ospedale Maria Vittoria, Torino, Italy. 19. Department of Cardiology, Ospedale Santa Chiara, Trento, Italy. 20. UNINA Department of Advanced Biomedical Sciences, Azienda Ospedaliera Universitaria Federico II, Naples, Italy. 21. Department of Cardiology, Azienda Ospedaliera Universitaria S.Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy. 22. Department of Clinical Research, BIOTRONIK Italia, Vimodrone (MI), Italy. 23. Department of Arrhythmias, CardioArrhythmology Center, Rome, Italy.
Abstract
OBJECTIVES: This study evaluated the temporal association between atrial high-rate episodes (AHREs) and sustained ventricular arrhythmias (VAs) in a remotely monitored cohort with implantable cardioverter-defibrillators (ICD) with and/or without cardiac resynchronization therapy with a defibrillator (CRT-D). BACKGROUND: Clinical relevance of AHREs in terms of VA rate and survival has not been outlined yet. METHODS: This study analyzed data of patients with ICDs and CRT-Ds from the nationwide Home Monitoring Expert Alliance network. The cohort included 2,435 patients with a median follow-up of 25 months (interquartile range: 13 to 42 months) and age 70 years (range 61 to 77 years); 19.7% were women, 51.4% had coronary artery disease, and 45.2% had a CRT-D. There were 3,410 appropriate VA episodes; 498 (14.6%) were preceded by AHREs within 48 h; in 85.5% of this group, AHREs were still ongoing at episode onset. RESULTS: In a longitudinal analysis, the odds ratios (ORs) of experiencing any VA in a 30-day interval with AHREs versus intervals without AHREs were 2.35 (95% confidence interval [CI]: 1.86 to 2.97; p < 0.001) for ventricular tachycardia (VT), 3.06 (95% CI: 2.35 to 3.99; p < 0.001) for fast VT, 1.84 (95% CI: 1.36 to 2.48; p < 0.001) for self-extinguishing ventricular fibrillation (VF), and 2.31 (95% CI: 1.17 to 4.57; p = 0.01) for VF. ORs decreased with increasing AHRE burden. Patients with AHREs 48 h before VAs were more likely to experience VA recurrences (adjusted hazard ratio [HR]: 1.78; 95% CI: 1.41 to 2.24; p < 0.001) and had higher overall mortality (HR: 2.67; 95% CI: 1.68 to 4.23; p < 0.001). CONCLUSIONS: AHREs were not uncommon 48 h before VAs, which tended to be distributed around intervals with AHREs. Temporal connection between AHREs and VAs was a marker of increased risk of VA recurrence and a poorer prognosis.
OBJECTIVES: This study evaluated the temporal association between atrial high-rate episodes (AHREs) and sustained ventricular arrhythmias (VAs) in a remotely monitored cohort with implantable cardioverter-defibrillators (ICD) with and/or without cardiac resynchronization therapy with a defibrillator (CRT-D). BACKGROUND: Clinical relevance of AHREs in terms of VA rate and survival has not been outlined yet. METHODS: This study analyzed data of patients with ICDs and CRT-Ds from the nationwide Home Monitoring Expert Alliance network. The cohort included 2,435 patients with a median follow-up of 25 months (interquartile range: 13 to 42 months) and age 70 years (range 61 to 77 years); 19.7% were women, 51.4% had coronary artery disease, and 45.2% had a CRT-D. There were 3,410 appropriate VA episodes; 498 (14.6%) were preceded by AHREs within 48 h; in 85.5% of this group, AHREs were still ongoing at episode onset. RESULTS: In a longitudinal analysis, the odds ratios (ORs) of experiencing any VA in a 30-day interval with AHREs versus intervals without AHREs were 2.35 (95% confidence interval [CI]: 1.86 to 2.97; p < 0.001) for ventricular tachycardia (VT), 3.06 (95% CI: 2.35 to 3.99; p < 0.001) for fast VT, 1.84 (95% CI: 1.36 to 2.48; p < 0.001) for self-extinguishing ventricular fibrillation (VF), and 2.31 (95% CI: 1.17 to 4.57; p = 0.01) for VF. ORs decreased with increasing AHRE burden. Patients with AHREs 48 h before VAs were more likely to experience VA recurrences (adjusted hazard ratio [HR]: 1.78; 95% CI: 1.41 to 2.24; p < 0.001) and had higher overall mortality (HR: 2.67; 95% CI: 1.68 to 4.23; p < 0.001). CONCLUSIONS: AHREs were not uncommon 48 h before VAs, which tended to be distributed around intervals with AHREs. Temporal connection between AHREs and VAs was a marker of increased risk of VA recurrence and a poorer prognosis.
Authors: Teresa Strisciuglio; Giuseppe Ammirati; Valerio Pergola; Lucio Addeo; Maria Angela Losi; Aniello Viggiano; Livio Imparato; Vincenzo Russo; Enrico Melillo; Gerardo Nigro; Giuseppe Stabile; Antonio D'Onofrio; Giovanni Esposito; Antonio Rapacciuolo Journal: J Clin Med Date: 2021-04-23 Impact factor: 4.241