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© 2021. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

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%.

Details

Title
Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation
Author
Rapacciuolo, Antonio 1   VIAFID ORCID Logo  ; Iacopino, Saverio 2   VIAFID ORCID Logo  ; D'Onofrio, Antonio 3 ; Curnis, Antonio 4 ; Pisanò, Ennio C. 5 ; Biffi, Mauro 6   VIAFID ORCID Logo  ; Della Bella, Paolo 7   VIAFID ORCID Logo  ; Dello Russo, Antonio 8 ; Caravati, Fabrizio 9 ; Zanotto, Gabriele 10 ; Calvi, Valeria 11 ; Rovaris, Giovanni 12 ; Senatore, Gaetano 13 ; Nicolis, Daniele 14 ; Santamaria, Matteo 15 ; Giammaria, Massimo 16   VIAFID ORCID Logo  ; Maglia, Giampiero 17 ; Duca, Antonio 18 ; Ammirati, Giuseppe 1 ; Romano, Salvo Andrea 19 ; Piacenti, Marcello 20 ; Celentano, Eduardo 21 ; Bisignani, Giovanni 22 ; Vaccaro, Paola 23 ; Miracapillo, Gennaro 24 ; Bertini, Matteo 25 ; Nigro, Gerardo 26 ; Giacopelli, Daniele 27   VIAFID ORCID Logo  ; Gargaro, Alessio 28   VIAFID ORCID Logo  ; Bisceglia, Caterina 7 

 Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy 
 Villa Maria Care & Research, Cotignola, Italy 
 Ospedale Monaldi, Naples, Italy 
 Spedali Civili, Brescia, Italy 
 Ospedale Vito Fazzi, Lecce, Italy 
 Policlinico Sant'Orsola‐Malpighi, Bologna, Italy 
 IRCCS San Raffaele Scientific Institute, Milan, Italy 
 Ospedali Riuniti, Ancona, Italy 
 ASST dei sette laghi, Ospedale di Circolo, Varese, Italy 
10  Ospedale Mater Salutis, Legnago, Italy 
11  Policlinico G. Rodolico, Az. O.U. Policlinico ‐ V. Emanuele, Catania, Italy 
12  Ospedale San Gerardo, Monza, Italy 
13  Ospedale di Ciriè, Ciriè, Italy 
14  Ospedale di Mantova, Mantova, Italy 
15  Gemelli Molise Hospital, Campobasso, Italy 
16  Ospedale Maria Vittoria, Torino, Italy 
17  Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy 
18  IRCCS Neurolesi‐Ospedale Piemonte, Messina, Italy 
19  Ospedale di Desio, Desio, Italy 
20  Fondazione Toscana Gabriele Monasterio, Pisa, Italy 
21  Humanitas Gavazzeni, Bergamo, Italy 
22  Ospedale “Ferrari”, Castrovillari, Italy 
23  AOR Villa Sofia‐Cervello P.O. Cervello, Palermo, Italy 
24  Ospedale di Grosseto, Grosseto, Italy 
25  University of Ferrara, S. Anna Hospital, Ferrara, Italy 
26  University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy 
27  Biotronik Italia S.p.a., Vimodrone, Italy, University of Padova, Padova, Italy 
28  Biotronik Italia S.p.a., Vimodrone, Italy 
Pages
5204-5212
Section
Original Articles
Publication year
2021
Publication date
Dec 1, 2021
Publisher
John Wiley & Sons, Inc.
e-ISSN
20555822
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2614534733
Copyright
© 2021. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.