Atrial fibrillation burden and subsequent heart failure events in patients with cardiac resynchronization therapy devices

• Published in: Journal of cardiovascular electrophysiology Vol. 31; no. 6; pp. 1519 - 1526
• Main Authors: Tanawuttiwat, Tanyanan, Lande, Jeff, Smeets, Pascal, Gerritse, Bart, Nazarian, Saman, Guallar, Eliseo, Cheng, Alan
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-06-2020
• Subjects: acute decompensated heart failure; Aged; atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; Cardiac arrhythmia; cardiac resynchronization therapy; Cardiac Resynchronization Therapy - adverse effects; Cardiac Resynchronization Therapy Devices; Congestive heart failure; Defibrillators; Female; Fibrillation; Heart failure; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - physiopathology; Heart Failure - therapy; heart failure hospitalization; Heart Rate; Humans; Male; Middle Aged; Prevalence; Prognosis; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Statistical analysis; Stroke Volume; Time Factors; Ventricular Function, Left; heart failure; acute decompensated heart failure; atrial fibrillation; cardiac resynchronization therapy; heart failure hospitalization
• DOI: 10.1111/jce.14444
• EISSN: 1540-8167
• ISSN: 1045-3873

Background
Atrial fibrillation (AF) and heart failure (HF) often coexist but little is known on how AF burden associates with subsequent episodes of HF.
Objective
The aim of this study was to quantitatively assess the short‐ and long‐term association of AF burden with subsequent episodes of HF events in patients with reduced ejection fraction.
Methods
Patients with cardiac resynchronization therapy (CRT) devices with at least 90 days of device data were included in the study. Time‐dependent Cox regression with a 7‐day window was used to evaluate the association of short‐ and long‐term AF burden with subsequent HF events. Each patient with HF was matched to two control patients without an HF event based on age, gender, year of implant and CRT defibrillation capability.
Results
In our cohort with 2:1 matching (N = 549), 183 patients developed HF events and 275 (50.1%) had AF over an average follow‐up of 24 ± 11 months. A 1‐hour increase in short‐term AF burden was associated with a 3% increased risk of HF events (HR, 1.034; 95% confidence interval [CI], 1.012‐1.056; P = .01; HR for 24‐hour = 2.23). In contrast, the association between long‐term AF burden and subsequent HF events was not statistically significant (HR, 1.009; 95% CI, 0.992‐1.026; P = .373).
Conclusion
A 24‐hour increase in AF burden is associated with a more than two‐fold increased risk of HF events over the subsequent week while the long‐term AF burden is not significantly associated with HF events.