Atrial fibrillation is under-recognized in chronic heart failure: Insights from a heart failure cohort treated with cardiac resynchronization therapy

Jane C. Caldwell, Hussain Contractor, Sanjiv Petkar, Razwan Ali, Bernard Clarke, Clifford J. Garratt, Ludwig Neyses, Mamas A. Mamas

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Aims: Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with chronic heart failure (CHF). Under-detection of asymptomatic paroxysmal AF (PAF) underestimates the true burden of AF in patients with CHF. We retrospectively studied the prevalence of asymptomatic PAF in 162 CHF patients through analysis of cardiac resynchronization therapy (CRT) device downloads to determine whether these episodes are associated with adverse outcomes.Methods and resultsAn episode of AF was defined by mode switching on CRT devices with an atrial rate >200 for at least 30 s. Of the 101 patients thought to be persistently in sinus rhythm (SR), 27 were found to have significant paroxysms of AF, with the cumulative percentage of time in the 'mode-switch mode' (i.e. the AF burden) of 1.6 ± 0.9. Mortality was 19.2 in patients with newly identified PAF with hospitalization and thrombo-embolism rates of 42.3 and 2.1, respectively, compared with mortality of 10.4 with hospitalization and thrombo-embolism rates of 41.8 and 1.9, respectively, in patients persistently in SR (P= NS).ConclusionAnalysis of data from CRT devices in a population of CHF patients with severe left ventricular dysfunction shows that a significant proportion of those perceived to be persistently in SR have undiagnosed paroxysms of AF but with relatively low burden. These episodes appear to be associated with a trend towards increased mortality but no effects on hospitalization or thrombo-embolism rates.
    Original languageEnglish
    Pages (from-to)1295-1300
    Number of pages5
    JournalEuropace
    Volume11
    Issue number10
    DOIs
    Publication statusPublished - Oct 2009

    Keywords

    • Atrial fibrillation
    • CRT
    • Heart failure

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