Korean Circ J.  2023 Jul;53(7):483-496. 10.4070/kcj.2022.0342.

Clinical Implications of DeviceDetected Atrial Fibrillation in Cardiac Resynchronization Therapy

• Yoon M
• Oh J
• Chun KH
• Yu HT
• Lee CJ
• Kim TH
• Pak HN
• Lee MH
• Joung B
• Kang SM

• KMID: 2545134
• DOI: http://doi.org/10.4070/kcj.2022.0342

Abstract

Background and Objectives
Atrial fibrillation (AF) is associated with decreased cardiac resynchronization therapy (CRT) benefits compared to sinus rhythm (SR). Effective biventricular (BiV) pacing is a determinant of CRT success, but AF can interfere with adequate BiV pacing and affect clinical outcomes. We investigated the effect of device-detected AF on clinical outcomes and optimal BiV pacing in patients with heart failure (HF) treated with CRT.
Methods
We retrospectively analyzed 174 patients who underwent CRT implantation between 2012 and 2019 at a tertiary center. The optimal BiV pacing percentage was defined as ≥98%. Device-detected AF was defined as an atrial high-rate episode ≥180 beats per minute lasting more than 6 minutes during the follow-up period. We stratified the patients without preexisting AF at pre-implantation into device-detected AF and no-AF groups.
Results
A total of 120 patients did not show preexisting AF at pre-implantation, and 54 had AF. Among these 120 patients, 19 (15.8%) showed device-detected AF during a median follow-up of 25.1 months. The proportion of optimal BiV pacing was significantly lower in the device-detected AF group than in the no-AF group (42.1% vs. 75.2%, p=0.009). The devicedetected AF group had a higher incidence of HF hospitalization, cardiovascular death, and all-cause death than the no-AF group. The device-detected AF and previous AF groups showed no significant differences regarding the percentage of BiV pacing and clinical outcomes.
Conclusions
For HF patients implanted with CRT, device-detected AF was associated with lower optimal BiV pacing and worse clinical outcomes than no-AF.

Keyword

Cardiac resynchronization therapy; Atrial fibrillation; Heart failure

Figure

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  Figure 1 Patients enrollment algorithm.AF = atrial fibrillation; CRT = cardiac resynchronization therapy.

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  Figure 2 The BiV pacing rate according to device-detected AF in patients without preexisting AF at pre-implantation.(A) BiV pacing percentage. (B) Proportion of optimal BiV pacing (≥98%). Error bars reflect standard errors.AF = atrial fibrillation; BiV = biventricular.

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  Figure 3 The Kaplan-Meier survival curves of the clinical outcomes between the device-detected AF and no-AF groups.(A) HF hospitalization, (B) cardiovascular death, (C) all-cause death, and (D) appropriate ICD therapy.AF = atrial fibrillation; CRT = cardiac resynchronization therapy; HF = heart failure; ICD = implantable cardioverter-defibrillator.*Appropriate ICD therapy was evaluated only for the patients with CRT-defibrillator.

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  Figure 4 The Kaplan-Meier survival curves of the clinical outcomes for the patients in each AF groups.(A) HF hospitalization, (B) cardiovascular death, (C) all-cause death, and (D) appropriate ICD therapy.AF = atrial fibrillation; AVNA = atrioventricular nodal ablation; CRT = cardiac resynchronization therapy; HF = heart failure; ICD = implantable cardioverter-defibrillator.*Appropriate ICD therapy was evaluated only for the patients with CRT-defibrillator.

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