Atrial Fibrillation in Cardiac Resynchronization Therapy with a Defibrillator: A Risk Factor for Mortality, Appropriate and Inappropriate Shocks

作者：Van Boven Nick; Theuns Dominic; Bogaard Kjell; Ruiter Jaap; Kimman Geert; Berman Lily; Van der Ploeg Tjeerd; Kardys Isabella; Umans Victor^*

来源：Journal of Cardiovascular Electrophysiology, 2013, 24(10): 1116-1122.

DOI：10.1111/jce.12208

• atrial fibrillation
• cardiac resynchronization therapy
• heart failure
• implantable cardioverter defibrillator
• mortality

Atrial Fibrillation in CRT-D
IntroductionKnowledge about predictive factors for mortality and (in)appropriate shocks in cardiac resynchronization therapy with a defibrillator (CRT-D) should be available and updated to predict clinical outcome.
MethodsWe retrospectively analyzed 543 consecutive patients assigned to CRT-D in 2 tertiary medical centers. The aim of this study was to assess risk factors for all-cause mortality, appropriate and inappropriate shocks.
ResultsMean follow-up time was 3.2 (1.8) years. A total of 110 (20%) patients died, 71 (13%) received 1 appropriate shocks, and 33 (6.1%) received 1 inappropriate shocks. No patients received a His bundle ablation and biventricular pacing percentage was not analyzed. Multivariable Cox regression analysis showed that a history of atrial fibrillation (AF) (HR 1.74 CI 1.06-2.86), higher creatinine (HR 1.12; CI 1.08-1.16), and a poorer left ventricular ejection fraction (LVEF) (HR 0.97; CI 0.94-1.01) independently predict all-cause mortality. In the entire cohort, history of AF and secondary prevention were independent predictors of appropriate shocks and variables associated with inappropriate shocks were history of AF and QRS 150 milliseconds. In primary prevention patients, history of AF also predicted appropriate shocks as did ischemic cardiomyopathy and poorer LVEF. History of AF, QRS 150 milliseconds, and lower creatinine were associated with inappropriate shocks in this subgroup. Appropriate shocks increased mortality risk, but inappropriate shocks did not.
ConclusionIn symptomatic CHF patients treated with CRT-D, history of AF is an independent risk factor not only for mortality, but also for appropriate and inappropriate shocks. Further efforts in AF management may optimize the care in CRT-D patients.

• 出版日期2013-10