Rakesh Gopinathannair1, Arjun Sharma2, Paul Jones3, Connor English4, Stephen Furmanek4, Brian Olshansky5. 1. Kansas City Heart Rhythm Institute, 5100 W 110th St, Ste 200, Overland Park, KS, 66211, USA. drrakeshg@yahoo.com. 2. Medical Devices Consultants LLC, Saint Paul, MN, USA. 3. Boston Scientific Corp, Minneapolis, MN, USA. 4. University of Louisville, Louisville, KY, USA. 5. University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Abstract
BACKGROUND: Heart rate score (HRSc), the percentage of atrial sensed and paced beats in the largest 10 beat/min bin of a device histogram and mean intrinsic heart rate (MIHR), predicted survival in nonrandomized studies of implantable defibrillator (ICD) patients. We evaluated whether HRSc and MIHR independently predicted mortality and heart failure (HF) hospitalization in the prospective, randomized, controlled INTRINSIC RV trial. METHODS AND RESULTS: The INTRINSIC RV trial enrolled 1530 patients receiving dual-chamber ICDs. This analysis involves patients (n = 1471) for whom MIHR and HRSc data were available. Mean follow-up was 10.4 months. The relationship between pre-randomization MIHR and HRSc on the primary endpoint of all-cause mortality and HF hospitalization was assessed using multivariate regression and Cox modeling. As categorical variables, MIHR > 70 bpm and HRSc > 70% were considered high. RESULTS: The median baseline MIHR and HRSc were 74 (IQR = 16) and 50% (IQR = 20) respectively. As a continuous variable, for every 1% increase in HRSc, death/HF hospitalization increased by 1% (95%CI: 1.002-1.017; p = 0.01). Regression analysis showed baseline MIHR was associated with HRSc (p = 0.01); for every 1 beat/min increase in MIHR, HRSc increased by 1.8%. A MIHR > 70 bpm and HRSc ≥ 70% predicted, but were independently associated with, the primary endpoint (HR: 1.39; 95%CI: 1.10-1.76, p = 0.005 for MIHR and HR: 1.654; 95%CI: 1.11-2.46, p = 0.01 for HRSc). Male gender (HR: 0.75), history of HF (HR: 1.29), and atrial fibrillation (HR: 1.37) also predicted death/hospitalization in the Cox model. CONCLUSIONS: In this large, prospectively studied ICD population, HRSc was a robust and independent predictor of death/HF hospitalization. High MIHR and high HRSc were associated but each predicted outcomes independently.
BACKGROUND: Heart rate score (HRSc), the percentage of atrial sensed and paced beats in the largest 10 beat/min bin of a device histogram and mean intrinsic heart rate (MIHR), predicted survival in nonrandomized studies of implantable defibrillator (ICD) patients. We evaluated whether HRSc and MIHR independently predicted mortality and heart failure (HF) hospitalization in the prospective, randomized, controlled INTRINSIC RV trial. METHODS AND RESULTS: The INTRINSIC RV trial enrolled 1530 patients receiving dual-chamber ICDs. This analysis involves patients (n = 1471) for whom MIHR and HRSc data were available. Mean follow-up was 10.4 months. The relationship between pre-randomization MIHR and HRSc on the primary endpoint of all-cause mortality and HF hospitalization was assessed using multivariate regression and Cox modeling. As categorical variables, MIHR > 70 bpm and HRSc > 70% were considered high. RESULTS: The median baseline MIHR and HRSc were 74 (IQR = 16) and 50% (IQR = 20) respectively. As a continuous variable, for every 1% increase in HRSc, death/HF hospitalization increased by 1% (95%CI: 1.002-1.017; p = 0.01). Regression analysis showed baseline MIHR was associated with HRSc (p = 0.01); for every 1 beat/min increase in MIHR, HRSc increased by 1.8%. A MIHR > 70 bpm and HRSc ≥ 70% predicted, but were independently associated with, the primary endpoint (HR: 1.39; 95%CI: 1.10-1.76, p = 0.005 for MIHR and HR: 1.654; 95%CI: 1.11-2.46, p = 0.01 for HRSc). Male gender (HR: 0.75), history of HF (HR: 1.29), and atrial fibrillation (HR: 1.37) also predicted death/hospitalization in the Cox model. CONCLUSIONS: In this large, prospectively studied ICD population, HRSc was a robust and independent predictor of death/HF hospitalization. High MIHR and high HRSc were associated but each predicted outcomes independently.