Device-Detected Atrial Tachyarrhythmias Predict Adverse Outcome in Real-World Patients With Implantable Biventricular Defibrillators

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:57

Article

Santini, Massimo¹  Gasparini, Maurizio²  Landolina, Maurizio³  Lunati, Maurizio⁴  Proclemer, Alessandro⁵  Padeletti, Luigi⁶  Catanzariti, Domenico⁷  Molon, Giulio⁸  Botto, Giovanni Luca⁹  La Rocca, Laura¹⁰  Grammatico, Andrea¹⁰  Boriani, Giuseppe¹¹ 

[1] San Filippo Neri Hosp, Inst Cardiol, I-00135 Rome, Italy

[2] IRCCS, Ist Clin Humanitas, Dept Cardiol, Rozzano, Italy

[3] Fdn Policlin S Matteo IRCCS, Dept Cardiol, Pavia, Italy

[4] Osped Niguarda Ca Granda, Dept Cardiol, Milan, Italy

[5] S Maria della Misericordia Hosp, Dept Cardiol, Udine, Italy

[6] Univ Florence, Dept Cardiol, Florence, Italy

[7] S Maria da Carmine Hosp, Dept Cardiol, Rovereto, Italy

[8] Sacro Cuore Hosp, Dept Cardiol, Negrar, Italy

[9] St Anna Hosp, Dept Cardiol, Como, Italy

[10] Medtron Italia, Clin Dept, Rome, Italy

[11] Univ Bologna, Dept Cardiol, Bologna, Italy

关键词: atrial tachyarrhythmias;    cardiac resynchronization;    clinical outcomes;    defibrillator;    heart failure;   

DOI  :  10.1016/j.jacc.2010.08.624

来源: Elsevier

【 摘 要 】

Objectives The purpose of this analysis was to evaluate the correlation between atrial tachycardia (AT) or atrial fibrillation (AF) and clinical outcomes in heart failure (HF) patients implanted with a cardiac resynchronization therapy defibrillator (CRT-D). Background In HF patients, AT and AF have high prevalence and are associated with compromised hemodynamic function. Methods Forty-four Italian cardiological centers followed up 1,193 patients who received a CRT-D according to current guidelines for advanced HF, New York Heart Association functional class >= II, left ventricular ejection fraction <35%, and QRS complex >120 ms. All patients were in sinus rhythm at implant. Results During a median follow-up period of 13 months, AT/AF >10 min occurred in 361 of 1,193 (30%) patients. The composite end point (deaths or HF hospitalizations) occurred in 174 of 1,193 (14.6%). Multivariate time-dependent Cox regression analyses showed that composite end point risk was higher among patients with device-detected AT/AF (hazard ratio [HR]: 2.16, p = 0.032), New York Heart Association functional class III or IV compared with II (HR: 2.09, p = 0.002), and absence of beta-blockers (HR: 1.36, p = 0.036). Furthermore, the composite end point risk was inversely associated with left ventricular ejection fraction (HR: 1.04, p = 0.045), increasing by a factor of 4% for each 1% decrease in left ventricular ejection fraction. Conclusions In HF patients with CRT-D, device-detected AT/AF is associated with a worse prognosis. Continuous device diagnostics monitoring and Web-based alerts may inform the physician of AT/AF occurrences and identify patients at risk of cardiac deterioration or patients with suboptimal rate or rhythm control. (Italian Clinical Service Project; NCT01007474) (J Am Coll Cardiol 2011;57:167-72) (C) 2011 by the American College of Cardiology Foundation

【 授权许可】

Free