ESC Heart Failure (Dec 2021)

Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation

  • Antonio Rapacciuolo,
  • Saverio Iacopino,
  • Antonio D'Onofrio,
  • Antonio Curnis,
  • Ennio C. Pisanò,
  • Mauro Biffi,
  • Paolo Della Bella,
  • Antonio Dello Russo,
  • Fabrizio Caravati,
  • Gabriele Zanotto,
  • Valeria Calvi,
  • Giovanni Rovaris,
  • Gaetano Senatore,
  • Daniele Nicolis,
  • Matteo Santamaria,
  • Massimo Giammaria,
  • Giampiero Maglia,
  • Antonio Duca,
  • Giuseppe Ammirati,
  • Salvo Andrea Romano,
  • Marcello Piacenti,
  • Eduardo Celentano,
  • Giovanni Bisignani,
  • Paola Vaccaro,
  • Gennaro Miracapillo,
  • Matteo Bertini,
  • Gerardo Nigro,
  • Daniele Giacopelli,
  • Alessio Gargaro,
  • Caterina Bisceglia

DOI
https://doi.org/10.1002/ehf2.13599
Journal volume & issue
Vol. 8, no. 6
pp. 5204 – 5212

Abstract

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Abstract Aims There are conflicting data on the benefit of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with permanent atrial fibrillation (AF). We aimed to compare patient outcomes according to the presence or absence of permanent AF at device implantation. Methods and results We retrospectively analysed remote monitoring data from 1141 CRT defibrillators. Propensity score with inverse‐probability weighting method was used to balance AF and sinus rhythm (SR) groups. Analysis endpoints included total mortality, appropriate defibrillation shocks, and CRT percentage. There were 229 patients (20.1%) in the AF group and 912 patients (79.9%) in the SR group. Compared with SR patients, AF patients were older (median age, 77 vs. 72 years, P < 0.001), more frequently male (82.5% vs. 75.5%, P = 0.02), and had higher heart rate (75.7 vs. 71.0 b.p.m., P < 0.001). Of the 229 AF patients, 162 (70.7%) received suboptimal CRT (<98%) and 67 (29.3%) had adequate CRT (≥98%). During a median follow‐up of 24 months, total mortality did not differ between AF and SR groups (propensity‐score‐weighted hazard ratio, HR 1.32 [95% confidence interval, 0.82–2.15], P = 0.25). The risk of appropriate shocks was significantly higher in the AF group with <98% CRT than in the SR group (weighted‐HR, 1.99 [1.21–3.26], P = 0.006) and was similar in the AF group with ≥98% CRT versus the SR group (1.29 [0.66–2.53], P = 0.45). During follow‐up, sinus rhythm was recovered in 23 patients in the AF group (10%) after a median time of 106 (42–256) days. The rate of sinus rhythm recovery in the AF group was 4.5 (95% CI, 2.8–6.7) per 100 patient‐years; the rate of permanent AF occurrence in the SR group was 2.5 (95% CI, 1.9–3.3) per 100 patient‐years. Conclusions Although mortality was similar across patient groups, patients with permanent AF and suboptimal CRT had twofold higher risk of appropriate shocks than SR patients or AF patients with CRT ≥ 98%.

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