Incidence and clinical relevance of uncontrolled ventricular rate during atrial fibrillation in heart failure patients treated with cardiac resynchronization therapy

Giuseppe Boriani, Maurizio Gasparini, Maurizio Landolina, Maurizio Lunati, Alessandro Proclemer, Gabriele Lonardi, Saverio Iacopino, Werner Rahue, Mauro Biffi, Paola Distefano, Andrea Grammatico, Massimo Santini

Research output: Contribution to journalArticlepeer-review

Abstract

Aims Uncontrolled ventricular rate (VR) during atrial fibrillation (AF) may cause clinical deterioration in heart failure (HF) patients who need continuous biventricular pacing to achieve cardiac resynchronization therapy (CRT). We aimed at evaluating the association between AF, uncontrolled VR, and sub-optimal CRT, defined as low biventricular pacing percentage (BIVP). Methods and results All 1404 patients had HF, New York Heart Association (NYHA) ≥II, left ventricular ejection fraction (LVEF) ≤35, and QRS ≥120 ms, and received an implantable CRT defibrillator (CRT-D). Occurrence of AF, VR during AF and lifetime BIVP were estimated from device data. Ventricular rate during AF was defined as uncontrolled in patients with mean VR>80 bpm and maximum VR>110 bpm. Over a median follow-up of 18 months, AF was detected in 443 of 1404 patients (32). In this sub-group of AF patients, VR during AF was uncontrolled in 150 of 443 patients (34). Multivariate Cox regression analysis showed that age [hazard ratio (HR) 1.03, 95 confidence interval (CI) 1.001.06, P 0.028], and uncontrolled VR [HR 1.69 (CI 1.012.83), P 0.046] were the only independent predictors of clinical outcome, assessed by HF hospitalizations and death. The median lifetime BIVP was 95 (2575 percentile range 9199). Biventricular pacing percentage was significantly and inversely correlated to VR, decreasing by 7 for each 10 bpm increase in VR. Sub-optimal CRT, defined as BIVP

Original languageEnglish
Pages (from-to)868-876
Number of pages9
JournalEuropean Journal of Heart Failure
Volume13
Issue number8
DOIs
Publication statusPublished - Aug 2011

Keywords

  • Atrial fibrillation
  • Cardiac resynchronization therapy
  • Clinical outcomes
  • Heart failure
  • Ventricular rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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