Atrial Tachyarrhythmias Temporally Precede Fluid Accumulation in Implantable Device Patients

Andriulli, Angelo; Moore, Hans; Hettrick, Douglas A.; Ousdigian, Kevin T.; Johnson, James W.; Markowitz, Steven M.

doi:10.1111/pace.12309

Cited by 5 publications

(6 citation statements)

References 23 publications

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“…This hypothesis is supported by the study from Andriulli et al who found a high probability of fluid index threshold crossing events, reflecting worsening HF, in the first month following the onset of AT/AF. The permanent AF patients were less likely to experience fluid index threshold crossing events 14 …”

Section: Discussionmentioning

confidence: 97%

Atrial fibrillation burden and subsequent heart failure events in patients with cardiac resynchronization therapy devices

Tanawuttiwat

Lande

Smeets

et al. 2020

Cardiovasc electrophysiol

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Background: Atrial fibrillation (AF) and heart failure (HF) often coexist but little is known on how AF burden associates with subsequent episodes of HF.Objective: The aim of this study was to quantitatively assess the short-and long-term association of AF burden with subsequent episodes of HF events in patients with reduced ejection fraction.Methods: Patients with cardiac resynchronization therapy (CRT) devices with at least 90 days of device data were included in the study. Time-dependent Cox regression with a 7-day window was used to evaluate the association of short-and long-term AF burden with subsequent HF events. Each patient with HF was matched to two control patients without an HF event based on age, gender, year of implant and CRT defibrillation capability.Results: In our cohort with 2:1 matching (N = 549), 183 patients developed HF events and 275 (50.1%) had AF over an average follow-up of 24 ± 11 months. A 1-hour increase in short-term AF burden was associated with a 3% increased risk of HF events (HR, 1.034; 95% confidence interval [CI], 1.012-1.056; P = .01; HR for 24-hour = 2.23). In contrast, the association between long-term AF burden and subsequent HF events was not statistically significant (HR, 1.009; 95% CI, 0.992-1.026; P = .373). Conclusion:A 24-hour increase in AF burden is associated with a more than twofold increased risk of HF events over the subsequent week while the long-term AF burden is not significantly associated with HF events. K E Y W O R D S acute decompensated heart failure, atrial fibrillation, cardiac resynchronization therapy, heart failure, heart failure hospitalization 1 | INTRODUCTION More than half of HF individuals develop AF and more than one-third of AF individuals develop HF. 1 Patients with both conditions often have a worse prognosis when compared with patients with either condition alone 2,3 Current estimates of AF prevalence are based on documented symptomatic AF events. Cardiac implantable electronic devices have been recognized as a robust way to provide continuous rhythm monitoring and detect episodes of subclinical AF. A portion of the results was presented at the 2018 AHA Scientific Sessions.

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Section: Discussionmentioning

confidence: 97%

Atrial fibrillation burden and subsequent heart failure events in patients with cardiac resynchronization therapy devices

Tanawuttiwat

Lande

Smeets

et al. 2020

Cardiovasc electrophysiol

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“…Neurohormonal activation, electrolyte disturbances, and myocardial ischemia during acute HF may also exert proarrhythmic influences in the myocardium [18]. OVFI values calculated from ITI trends have been validated to inversely correlate with pulmonary capillary wedge pressure and fluid balance and with changes in N-terminal pro-hormone brain natriuretic peptide [8,12]. Multiple studies have investigated the association between decreased ITI quantified by the OVFI and both AT/AF and VT/VF in patients with HFrEF [8,19].…”

Section: Discussionmentioning

confidence: 99%

“…OVFI values calculated from ITI trends have been validated to inversely correlate with pulmonary capillary wedge pressure and fluid balance and with changes in N-terminal pro-hormone brain natriuretic peptide [8,12]. Multiple studies have investigated the association between decreased ITI quantified by the OVFI and both AT/AF and VT/VF in patients with HFrEF [8,19]. A meta-analysis summarizing the published evidence of the association between OVFI and development of AT/AF and VT/VF reported a statistically significant association between increased OVFI and AT/AF and VT/VF onset in patients with HFrEF.…”

Section: Discussionmentioning

confidence: 99%

“…Determination of the ITI-derived fluid index (OptiVol™, OVFI, Medtronic Inc., Minneapolis, MN, USA) was described previously [8]. Briefly, ITI is measured each day directly between the right ventricular lead and the device metal case to determine an average daily impedance value.…”

Section: Iti Measurementmentioning

confidence: 99%

“…The broad adoption of CIEDs has provided a unique platform to develop ancillary sensor technologies to better understand longitudinal physiological alterations in AT/AF and fluid overload. Multiple studies have attempted to investigate the association between decreased thoracic impedance quantified by the OVFI and AT/AF [7,8]. However, most patients in those clinical studies related to OVFI have HFrEF [9].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Relationship between Atrial Tachyarrhythmias and Intrathoracic Impedance in Patients with a Pacemaker and Preserved Ejection Fraction

Liao

Chen

Lin

et al. 2019

JCM

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Atrial fibrillation (AF) is responsible for significant morbidity and mortality in patients with heart failure (HF). Modern pacemakers provide an index of intrathoracic fluid status (OptiVol fluid index—OVFI) by measuring daily intrathoracic impedance. This study aimed to determine whether OVFI is associated with increased atrial tachycardia/fibrillation (AT/AF) events in patients with a preserved ejection fraction (EF). We retrospectively reviewed data from patients with Medtronic Advisa pacemakers between 2012 and 2014 in our hospital. The association and temporal relationship between OVFI and AT/AF events were determined. A total of 150 patients with 211 follow-up visits (mean 1.4 visits per patient) were evaluated. The device-detected AT/AF prevalence was 47%. Device-measured OVFI ≥ 20 Ω-days was significantly associated with the onset of AT/AF ≥ 4 h. OVFI threshold crossing preceded AT/AF events in 55.1% of cases, followed by AT/AF events in only 18.7%. Fluid overload represented by OVFI may trigger AT/AF episodes in patients with a preserved EF more often than that previously reported in patients with a reduced EF. Our findings support the view that worsening pulmonary congestion is associated with increased AT/AF frequency and suggests that fluid overload could trigger and perpetuate AT/AF events in patients with a preserved EF.

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Intra-thoracic Impedance and the Onset of Atrial and Ventricular Tachyarrhythmias: A Meta-analysis

Abubakar

Akintoye

Subahi

et al. 2018

International Journal of Cardiology

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Atrial Tachyarrhythmias Temporally Precede Fluid Accumulation in Implantable Device Patients

Cited by 5 publications

References 23 publications

Atrial fibrillation burden and subsequent heart failure events in patients with cardiac resynchronization therapy devices

Atrial fibrillation burden and subsequent heart failure events in patients with cardiac resynchronization therapy devices

Relationship between Atrial Tachyarrhythmias and Intrathoracic Impedance in Patients with a Pacemaker and Preserved Ejection Fraction

Intra-thoracic Impedance and the Onset of Atrial and Ventricular Tachyarrhythmias: A Meta-analysis

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