Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation
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 res...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-12-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13599 |
| _version_ | 1817988046805532672 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Antonio Rapacciuolo |
| collection | DOAJ |
| description | 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%. |
| first_indexed | 2024-04-14T00:29:21Z |
| format | Article |
| id | doaj.art-9bbc018beb494779b3a67198a06ba984 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-14T00:29:21Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-9bbc018beb494779b3a67198a06ba9842022-12-22T02:22:36ZengWileyESC Heart Failure2055-58222021-12-01865204521210.1002/ehf2.13599Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillationAntonio Rapacciuolo0Saverio Iacopino1Antonio D'Onofrio2Antonio Curnis3Ennio C. Pisanò4Mauro Biffi5Paolo Della Bella6Antonio Dello Russo7Fabrizio Caravati8Gabriele Zanotto9Valeria Calvi10Giovanni Rovaris11Gaetano Senatore12Daniele Nicolis13Matteo Santamaria14Massimo Giammaria15Giampiero Maglia16Antonio Duca17Giuseppe Ammirati18Salvo Andrea Romano19Marcello Piacenti20Eduardo Celentano21Giovanni Bisignani22Paola Vaccaro23Gennaro Miracapillo24Matteo Bertini25Gerardo Nigro26Daniele Giacopelli27Alessio Gargaro28Caterina Bisceglia29Department of Advanced Biomedical Sciences Federico II University of Naples Corso Umberto I, 40 Naples 80138 ItalyVilla Maria Care & Research Cotignola ItalyOspedale Monaldi Naples ItalySpedali Civili Brescia ItalyOspedale Vito Fazzi Lecce ItalyPoliclinico Sant'Orsola‐Malpighi Bologna ItalyIRCCS San Raffaele Scientific Institute Milan ItalyOspedali Riuniti Ancona ItalyASST dei sette laghi, Ospedale di Circolo Varese ItalyOspedale Mater Salutis Legnago ItalyPoliclinico G. Rodolico, Az. O.U. Policlinico ‐ V. Emanuele Catania ItalyOspedale San Gerardo Monza ItalyOspedale di Ciriè Ciriè ItalyOspedale di Mantova Mantova ItalyGemelli Molise Hospital Campobasso ItalyOspedale Maria Vittoria Torino ItalyAzienda Ospedaliera Pugliese Ciaccio Catanzaro ItalyIRCCS Neurolesi‐Ospedale Piemonte Messina ItalyDepartment of Advanced Biomedical Sciences Federico II University of Naples Corso Umberto I, 40 Naples 80138 ItalyOspedale di Desio Desio ItalyFondazione Toscana Gabriele Monasterio Pisa ItalyHumanitas Gavazzeni Bergamo ItalyOspedale “Ferrari” Castrovillari ItalyAOR Villa Sofia‐Cervello P.O. Cervello Palermo ItalyOspedale di Grosseto Grosseto ItalyUniversity of Ferrara, S. Anna Hospital Ferrara ItalyUniversity of Campania “Luigi Vanvitelli,” Monaldi Hospital Naples ItalyBiotronik Italia S.p.a. Vimodrone ItalyBiotronik Italia S.p.a. Vimodrone ItalyIRCCS San Raffaele Scientific Institute Milan ItalyAbstract 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%.https://doi.org/10.1002/ehf2.13599Atrial fibrillationCardiac resynchronization therapyHeart failureHeart rateDefibrillation shock |
| spellingShingle | 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 Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation ESC Heart Failure Atrial fibrillation Cardiac resynchronization therapy Heart failure Heart rate Defibrillation shock |
| title | Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation |
| title_full | Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation |
| title_fullStr | Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation |
| title_full_unstemmed | Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation |
| title_short | Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation |
| title_sort | cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation |
| topic | Atrial fibrillation Cardiac resynchronization therapy Heart failure Heart rate Defibrillation shock |
| url | https://doi.org/10.1002/ehf2.13599 |
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