open access

Vol 22, No 3 (2015)
Original articles
Published online: 2015-06-19
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Atrial fibrillation in cardiac resynchronization recipients with and without prior arrhythmic history. How much of arrhythmia is too much?

Radosław Lenarczyk, Ewa Jędrzejczyk-Patej, Mariola Szulik, Michał Mazurek, Tomasz Podolecki, Jacek Kowalczyk, Oskar Kowalski, Beata Średniawa, Zbigniew Kalarus, for the Triple-Site Versus Standard Cardiac Resynchronization Trial (TRUST CRT) Investigators
DOI: 10.5603/CJ.a2014.0102
·
Pubmed: 25563708
·
Cardiol J 2015;22(3):267-275.

open access

Vol 22, No 3 (2015)
Original articles
Published online: 2015-06-19

Abstract

Background: The aim of the study was to assess long-term incidence of atrial fibrillation (AF) in cardiac resynchronization (CRT) recipients with and without prior arrhythmic history, factors predisposing to arrhythmia, as well as to evaluate the prognostic power of cumulative arrhythmia burden, duration of the longest episode and the number of episodes.

Methods: Device-collected data on AF episodes during 24 months in 96 participants of a randomized CRT-trial were analyzed (15% in NYHA class IV, sinus rhythm, median left ventricular ejection fraction 24% and QRS 169 ms). Blindly adjudicated major adverse car­diac events (MACE) and any-cause death were censoring variables.

Results: Two-year incidence of AF was 70%, including 66% of patients without previous AF history. No baseline characteristics distinguished those who developed new onset AF. Percent of time spent in AF, but not number of episodes predicted mortality (adjusted hazard ratio [HR] 1.05 ± 95% confidence interval CI 1.01–1.10) and MACE incidence (HR 1.03 ± 1.01–1.07; p = 0.03). Duration of the longest episode also predicted mortality (HR 1.06 ± 1.01–1.12; both p = 0.03). Prognostic impact of AF load was marked only in patients with slower ventricular response (< 98/min), but was independent from CHADS2 scores, pacing burden, or prior atrioventricular nodal ablation.

Conclusions: Seven out of 10 CRT-patients had AF within 2 years, including two-thirds of subjects without arrhythmic history. No baseline features distinguished those who developed new onset AF. Arrhythmia burden and duration of the longest episode, but not number of episodes influenced outcomes in CRT-patients, irrespectively from pacing burden or prior atrioventricular node ablation.  

Abstract

Background: The aim of the study was to assess long-term incidence of atrial fibrillation (AF) in cardiac resynchronization (CRT) recipients with and without prior arrhythmic history, factors predisposing to arrhythmia, as well as to evaluate the prognostic power of cumulative arrhythmia burden, duration of the longest episode and the number of episodes.

Methods: Device-collected data on AF episodes during 24 months in 96 participants of a randomized CRT-trial were analyzed (15% in NYHA class IV, sinus rhythm, median left ventricular ejection fraction 24% and QRS 169 ms). Blindly adjudicated major adverse car­diac events (MACE) and any-cause death were censoring variables.

Results: Two-year incidence of AF was 70%, including 66% of patients without previous AF history. No baseline characteristics distinguished those who developed new onset AF. Percent of time spent in AF, but not number of episodes predicted mortality (adjusted hazard ratio [HR] 1.05 ± 95% confidence interval CI 1.01–1.10) and MACE incidence (HR 1.03 ± 1.01–1.07; p = 0.03). Duration of the longest episode also predicted mortality (HR 1.06 ± 1.01–1.12; both p = 0.03). Prognostic impact of AF load was marked only in patients with slower ventricular response (< 98/min), but was independent from CHADS2 scores, pacing burden, or prior atrioventricular nodal ablation.

Conclusions: Seven out of 10 CRT-patients had AF within 2 years, including two-thirds of subjects without arrhythmic history. No baseline features distinguished those who developed new onset AF. Arrhythmia burden and duration of the longest episode, but not number of episodes influenced outcomes in CRT-patients, irrespectively from pacing burden or prior atrioventricular node ablation.  

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Keywords

atrial fibrillation, cardiac resynchronization therapy, heart failure, prognosis, atrial fibrillation burden

About this article
Title

Atrial fibrillation in cardiac resynchronization recipients with and without prior arrhythmic history. How much of arrhythmia is too much?

Journal

Cardiology Journal

Issue

Vol 22, No 3 (2015)

Pages

267-275

Published online

2015-06-19

DOI

10.5603/CJ.a2014.0102

Pubmed

25563708

Bibliographic record

Cardiol J 2015;22(3):267-275.

Keywords

atrial fibrillation
cardiac resynchronization therapy
heart failure
prognosis
atrial fibrillation burden

Authors

Radosław Lenarczyk
Ewa Jędrzejczyk-Patej
Mariola Szulik
Michał Mazurek
Tomasz Podolecki
Jacek Kowalczyk
Oskar Kowalski
Beata Średniawa
Zbigniew Kalarus
for the Triple-Site Versus Standard Cardiac Resynchronization Trial (TRUST CRT) Investigators

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