Device-detected atrial tachyarrhythmias predict adverse outcome in real-world patients with implantable biventricular defibrillators

Massimo Santini, Maurizio Gasparini, Maurizio Landolina, Maurizio Lunati, Alessandro Proclemer, Luigi Padeletti, Domenico Catanzariti, Giulio Molon, Giovanni Luca Botto, Laura La Rocca, Andrea Grammatico, Giuseppe Boriani

Research output: Contribution to journalArticle

Abstract

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 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 ClinicalService Project; NCT01007474)

Original languageEnglish
Pages (from-to)167-172
Number of pages6
JournalJournal of the American College of Cardiology
Volume57
Issue number2
DOIs
Publication statusPublished - Jan 11 2011

    Fingerprint

Keywords

  • atrial tachyarrhythmias
  • cardiac resynchronization
  • clinical outcomes
  • defibrillator
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Santini, M., Gasparini, M., Landolina, M., Lunati, M., Proclemer, A., Padeletti, L., Catanzariti, D., Molon, G., Botto, G. L., La Rocca, L., Grammatico, A., & Boriani, G. (2011). Device-detected atrial tachyarrhythmias predict adverse outcome in real-world patients with implantable biventricular defibrillators. Journal of the American College of Cardiology, 57(2), 167-172. https://doi.org/10.1016/j.jacc.2010.08.624