1
|
Rodio G, Iacopino S, Pisanò EC, Calvi V, Rovaris G, Marini M, Giammaria M, Caravati F, Maglia G, Zanotto G, Della Bella P, Biffi M, Curnis A, Maines M, Orsida D, Santamaria M, Bisignani G, Baroni M, Lissoni F, Duca A, Forleo GB, Piemontese C, De Salvia A, Miracapillo G, Celentano E, Zecchin M, Luzzi G, Giacopelli D, Gargaro A, D'Onofrio A. Temporal association between drops in thoracic impedance and malignant ventricular arrhythmia: A longitudinal analysis of remote monitoring trends. J Cardiovasc Electrophysiol 2023; 34:947-956. [PMID: 36709469 DOI: 10.1111/jce.15834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/23/2022] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Thoracic impedance (TI) drops measured by implantable cardioverter-defibrillators (ICDs) have been reported to correlate with ventricular tachycardia/fibrillation (VT/VF). The aim of our study was to assess the temporal association of decreasing TI trends with VT/VF episodes through a longitudinal analysis of daily remote monitoring data from ICDs and cardiac resynchronization therapy defibrillators (CRT-Ds). METHODS AND RESULTS Retrospective data from 2384 patients were randomized 1:1 into a derivation or validation cohort. The TI decrease rate was defined as the percentage of rolling weeks with a continuously decreasing TI trend. The derivation cohort was used to determine a TI decrease rate threshold for a ≥99% specificity of arrhythmia prediction. The associated risk of VT/VF episodes was estimated in the validation cohort by dividing the available follow-up into 60-day assessment intervals. Analyses were performed separately for 1354 ICD and 1030 CRT-D patients. During a median follow-up of 2.0 years, 727 patients (30.4%) experienced 3298 confirmed VT/VF episodes. In the ICD group, a TI decrease rate of >60% was associated with a higher risk of VT/VF episode in a 60-day assessment interval (stratified hazard ratio, 1.42; 95% confidence interval (CI), 1.05-1.92; p = .023). The TI decrease preceded (40.8%) or followed (59.2%) the VT/VF episodes. In the CRT-D group, no association between TI decrease and VT/VF episodes was observed (p = .84). CONCLUSION In our longitudinal analysis, TI decrease was associated with VT/VF episodes only in ICD patients. Preventive interventions may be difficult since episodes can occur before or after TI decrease.
Collapse
Affiliation(s)
- Giovanna Rodio
- Division of Cardiology, Ospedale Santissima Annunziata, Taranto, Italy
| | | | | | - Valeria Calvi
- Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", Catania, Italy
| | | | | | | | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | - Matteo Baroni
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | | | | | | | | | | | | | - Giovanni Luzzi
- Division of Cardiology, Ospedale Santissima Annunziata, Taranto, Italy
| | - Daniele Giacopelli
- Biotronik Italia S.P.A., Vimodrone, Italy
- University of Padova, Padua, Italy
| | | | | |
Collapse
|
2
|
Rodio G, Iacopino S, Pisanò EC, Calvi V, Rovaris G, Marini M, Giammaria M, Caravati F, Maglia G, Maines M, Orsida D, Santamaria M, Bisignani G, Baroni M, Lissoni F, Duca A, Luzzi G, Giacopelli D, Gargaro A, D´onofrio A. 336 TEMPORAL CONNECTION BETWEEN HOME MONITORING TRENDS OF THORACIC IMPEDANCE AND SUSTAINED VENTRICULAR ARRHYTHMIAS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
Implantable cardioverter defibrillators (ICDs) provide daily values of thoracic impedance (TI) that are inversely correlated with fluid accumulation in the lungs. Since sustained ventricular arrhythmias (SVA) are known to have a short-term relationship with heart failure exacerbations, our objective was to assess TI trends temporally related to SVA episodes.
Methods
This study analyzed data daily transmitted from patients with ICD or cardiac resynchronization therapy defibrillator (CRT-D) of the nationwide Home Monitoring Expert Alliance network. Device-detected SVAs were adjudicated for appropriateness. Patients were randomly split into a derivation and validation cohort. To identify the most significant TI trend (TI-index), several numerical TI transformations were tested in a cross-sectional analysis of the derivation cohort modelling the odds of first SVA with univariate logistic regressions. In the same cohort, the threshold of the selected transformation was identified to maximize the projected specificity. The relative risk of SVA for TI-index above threshold was estimated in the validation cohort by applying Cox proportional hazard models stratified by individual patients to 60-day duration windows. Analyses were performed separately in the ICD and CRT-D groups.
Results
The study cohort included 2,384 patients with 69 years of age (interquartile range: 60, 77); 19% were women, 42% had coronary artery disease, and 43% had a CRT-D. After a median follow-up of 2.0 (1.0, 3.4) years, there were 3,298 appropriate SVA episodes in 727 patients (30%).
The derived IT-index consisted of the percentage of 6-day intervals of the rolling average of TI values showing monotone decrease in the last 82 days. The increase in the risk of SVA was 3% (p<0.0001) per unit of percentage. The threshold of 60% of intervals with monotone decrease was associated with 99.9% projected specificity and 70.3% accuracy.
In the validation cohort, the TI-Index was associated with a 42% increased risk of SVA episodes in the ICD group (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.05-1.92, p=0.023). The TI-index exceeded the 60% threshold before the episode in 38% of the detected episodes. The association was not significant in the CRT-D group (HR 0.96, 95% CI 0.62-1.47, p=0.84).
Conclusions
In our analysis of remote monitoring data, a specific monotonic decreasing trend of TI was temporally associated with SVA in patients with ICD. Careful monitoring of TI can identify a period of susceptibility to ventricular arrhythmias that deserves more intensive attention.
Collapse
Affiliation(s)
| | | | | | - Valeria Calvi
- Azienda O.U. Policlinico G. Rodolico-San Marco Catania
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Maglia G, Giammaria M, Zanotto G, D'Onofrio A, Della Bella P, Marini M, Rovaris G, Iacopino S, Calvi V, Pisanò EC, Ziacchi M, Curnis A, Senatore G, Caravati F, Saporito D, Forleo GB, Pedretti S, Santobuono VE, Pepi P, De Salvia A, Balestri G, Maines M, Orsida D, Bisignani G, Baroni M, Lissoni F, Bertini M, Giacopelli D, Gargaro A, Biffi M. Ventricular Arrhythmias and Implantable Cardioverter-Defibrillator Therapy in Women: A Propensity Score-Matched Analysis. JACC Clin Electrophysiol 2022; 8:1553-1562. [PMID: 36543505 DOI: 10.1016/j.jacep.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/13/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Causes of sex differences in incidence of sustained ventricular arrhythmias (SVAs) are poorly understood. OBJECTIVES This study aims to investigate sex-specific risk of SVAs and device therapies by balancing sex groups in relation to several baseline characteristics with the propensity score (PS). METHODS We used a large remote monitoring dataset from implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds). Study endpoints were time to the first appropriate SVA, time to the first device therapy for SVA, and time to the first ICD shock. Results were compared between females and a PS-matched male subgroup. RESULTS In a cohort of 2,532 patients with an ICD or CRT-D (median age, 70 years), 488 patients (19.3%) were women. After selecting 488 men PS-matched for 19 variables relative to baseline demographics, implant indications, principal comorbidities, and concomitant therapy, yet the SVA rate at the 2.1-year median follow-up was significantly lower in women than in man (adjusted HR: 0.65; 95% CI: 0.51-0.81; P < 0.001). Women also showed a reduced risk of any device therapy (HR: 0.59; 95% CI: 0.45-0.76; P < 0.001) and shocks (HR: 0.66; 95% CI: 0.47-0.94; P = 0.021). Differences in sex-specific SVA risk profile were not confirmed in CRT-D patients (HR: 0.78; 95% CI: 0.55-1.09; P = 0.14) nor in those with an ejection fraction <30% (HR: 0.80; 95% CI: 0.52-1.23; P = 0.31). CONCLUSIONS After matching demographics, indications, principal comorbidities, and concomitant therapy, women still exhibited a lower SVA risk profile than men, except in the subgroups of CRT-D or/and ejection fraction <30%.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Valeria Calvi
- Azienda O.U. Policlinico G. Rodolico - San Marco, Catania, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Matteo Baroni
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | - Daniele Giacopelli
- Biotronik Italia S.p.a., Vimodrone (MI), Italy; University of Padova, Padova, Italy
| | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| |
Collapse
|
4
|
D’Onofrio A, Marini M, Rovaris G, Zanotto G, Calvi V, Iacopino S, Biffi M, Solimene F, Della Bella P, Caravati F, Pisanò EC, Amellone C, D’Alterio G, Pedretti S, Santobuono VE, Russo AD, Nicolis D, De Salvia A, Baroni M, Quartieri F, Manzo M, Rapacciuolo A, Saporito D, Maines M, Marras E, Bontempi L, Morani G, Giacopelli D, Gargaro A, Giammaria M. Prognostic significance of remotely monitored nocturnal heart rate in heart failure patients with reduced ejection fraction. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
5
|
Calvi V, Zanotto G, D'Onofrio A, Bisceglia C, Iacopino S, Pignalberi C, Pisanò EC, Solimene F, Giammaria M, Biffi M, Maglia G, Marini M, Senatore G, Pedretti S, Forleo GB, Santobuono VE, Curnis A, Russo AD, Rapacciuolo A, Quartieri F, Bertocchi P, Caravati F, Manzo M, Saporito D, Orsida D, Santamaria M, Bottaro G, Giacopelli D, Gargaro A, Bella PD. One-year mortality after implantable defibrillator implantation: do risk stratification models help improving clinical practice? J Interv Card Electrophysiol 2021; 64:607-619. [PMID: 34709504 DOI: 10.1007/s10840-021-01083-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to assess the available mortality risk stratification models for implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) patients. METHODS We conducted a review of mortality risk stratification models and tested their ability to improve prediction of 1-year survival after implant in a database of patients who received a remotely controlled ICD/CRT-D device during routine care and included in the independent Home Monitoring Expert Alliance registry. RESULTS We identified ten predicting models published in peer-reviewed journals between 2000 and 2021 (Parkash, PACE, MADIT, aCCI, CHA2DS2-VASc quartiles, CIDS, FADES, Sjoblom, AAACC, and MADIT-ICD non-arrhythmic mortality score) that could be tested in our database as based on common demographic, clinical, echocardiographic, electrocardiographic, and laboratory variables. Our cohort included 1,911 patients with left ventricular dysfunction (median age 71, 18.3% female) from sites not using any risk stratification score for systematic patient screening. Patients received an ICD (53.8%) or CRT-D (46.2%) between 2011 and 2017, after standard physician evaluation. There were 56 deaths within 1-year post-implant, with an all-cause mortality rate of 2.9% (95% confidence interval [CI], 2.3-3.8%). Four predicting models (Parkash, MADIT, AAACC, and MADIT-ICD non-arrhythmic mortality score) were significantly associated with increased risk of 1-year mortality with hazard ratios ranging from 3.75 (CI, 1.31-10.7) to 6.53 (CI 1.52-28.0, p ≤ 0.014 for all four). Positive predictive values of 1-year mortality were below 25% for all models. CONCLUSION In our analysis, the models we tested conferred modest incremental predicting power to ordinary screening methods.
Collapse
Affiliation(s)
- Valeria Calvi
- Policlinico G. Rodolico, Az. O.U. Policlinico - V. Via S. Sofia 78, 95123, Catania, Emanuele, Italy.
| | | | | | | | | | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Stefano Pedretti
- Ospedale Sant'Anna, ASST Lariana, San Fermo della Battaglia, CO, Italy
| | | | | | | | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | | | | | - Michele Manzo
- Azienda Ospedaliera Universitaria S.Giovanni Di Dio E Ruggi D'Aragona, Salerno, Italy
| | | | | | | | - Giuseppe Bottaro
- Policlinico G. Rodolico, Az. O.U. Policlinico - V. Via S. Sofia 78, 95123, Catania, Emanuele, Italy
| | | | | | | |
Collapse
|
6
|
Rapacciuolo A, Iacopino S, D'Onofrio A, Curnis A, Pisanò EC, Biffi M, Della Bella P, Dello Russo A, Caravati F, Zanotto G, Calvi V, Rovaris G, Senatore G, Nicolis D, Santamaria M, Giammaria M, Maglia G, Duca A, Ammirati G, Romano SA, Piacenti M, Celentano E, Bisignani G, Vaccaro P, Miracapillo G, Bertini M, Nigro G, Giacopelli D, Gargaro A, Bisceglia C. Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation. ESC Heart Fail 2021; 8:5204-5212. [PMID: 34514741 PMCID: PMC8712818 DOI: 10.1002/ehf2.13599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/22/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
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%.
Collapse
Affiliation(s)
- Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Corso Umberto I, 40, Naples, 80138, Italy
| | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | - Valeria Calvi
- Policlinico G. Rodolico, Az. O.U. Policlinico - V. Emanuele, Catania, Italy
| | | | | | | | | | | | | | - Antonio Duca
- IRCCS Neurolesi-Ospedale Piemonte, Messina, Italy
| | - Giuseppe Ammirati
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Corso Umberto I, 40, Naples, 80138, Italy
| | | | | | | | | | - Paola Vaccaro
- AOR Villa Sofia-Cervello P.O. Cervello, Palermo, Italy
| | | | | | - Gerardo Nigro
- University of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy
| | - Daniele Giacopelli
- Biotronik Italia S.p.a., Vimodrone, Italy.,University of Padova, Padova, Italy
| | | | | |
Collapse
|
7
|
Vergara P, Pignalberi C, Pisanò EC, Maglia G, Della Bella P, Zanotto G, Iacopino S, Solimene F, Calvi V, Marini M, Giammaria M, Biffi M, Rovaris G, Caravati F, Quartieri F, Curnis A, Rapacciuolo A, Senatore G, Pedretti S, Saporito D, Dello Russo A, Santobuono VE, Pepi P, Duca A, Baroni M, Falasconi G, Giacopelli D, Gargaro A, D'Onofrio A. Circadian periodicity affects the type of ventricular arrhythmias and efficacy of implantable defibrillator therapies. J Cardiovasc Electrophysiol 2021; 32:2528-2535. [PMID: 34252991 DOI: 10.1111/jce.15154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/14/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Factors influencing malignant arrhythmia onset are not fully understood. We explored the circadian periodicity of ventricular arrhythmias (VAs) in patients with implantable cardioverter and cardiac resynchronization defibrillators (ICD/CRT-D). METHODS Time, morphology (monomorphic/polymorphic), and mode of termination (anti-tachycardia pacing [ATP] or shock) of VAs stored in a database of remote monitoring data were adjudicated. Episodes were grouped in six 4-h timeslots from 00:00 to 24:00. Circadian distributions and adjusted marginal odds ratios (ORs), with 95% confidence interval (CI), were analyzed using mixed-effect models and logit generalized estimating equations, respectively, to account for within-subject correlation of multiple episodes. RESULTS Among 1303 VA episodes from 446 patients (63% ICD and 37% CRT-D), 120 (9%) self-extinguished, and 842 (65%) were terminated by ATP, 343 (26%) by shock. VAs clustered from 08:00 to 16:00 with 44% of episodes, as compared with 22% from 00:00 to 08:00 (p < .001) and 34% from 16:00 to 24:00 (p = .005). Episodes were more likely to be polymorphic at night with an adjusted marginal OR of 1.66 (CI, 1.15-2.40; p = .007) at 00:00-04:00 versus other timeslots. Episodes were less likely to be terminated by ATP in the 00:00-04:00 (success-to-failure ratio, 0.67; CI, 0.46-0.98; p = .039) and 08:00-12:00 (0.70; CI, 0.51-0.96; p = .02) timeslots, and most likely to be terminated by ATP between 12:00 and 16:00 (success-to-failure ratio 1.42; CI, 1.06-1.91; p = .02). CONCLUSION VAs did not distribute uniformly over the 24 h, with a majority of episodes occurring from 08:00 to 16:00. Nocturnal episodes were more likely to be polymorphic. The efficacy of ATP depended on the time of delivery.
Collapse
Affiliation(s)
- Pasquale Vergara
- Arrhythmia Unit and Electrophysiology Laboratory, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | | | | | - Paolo Della Bella
- Arrhythmia Unit and Electrophysiology Laboratory, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | | | | | - Valeria Calvi
- Policlinico G. Rodolico, Az. O.U. Policlinico-V. Emanuele, Catania, Italy
| | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Stefano Pedretti
- Ospedale Sant'Anna, ASST Lariana, San Fermo della Battaglia, Como, Italy
| | | | | | | | | | | | - Matteo Baroni
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulio Falasconi
- IRCCS San Raffaele Scientific Institute and Vita Salute University, Milano, Italy
| | | | | | | |
Collapse
|
8
|
Zecchin M, Solimene F, D'Onofrio A, Zanotto G, Iacopino S, Pignalberi C, Calvi V, Maglia G, Della Bella P, Quartieri F, Curnis A, Biffi M, Capucci A, Caravati F, Senatore G, Santamaria M, Lissoni F, Manzo M, Marini M, Giammaria M, Rapacciuolo A, Sinagra G, Giacopelli D, Gargaro A, Pisanò EC. Atrial signal amplitude predicts atrial high-rate episodes in implantable cardioverter defibrillator patients: Insights from a large database of remote monitoring transmissions. J Arrhythm 2020; 36:353-362. [PMID: 32256887 PMCID: PMC7132187 DOI: 10.1002/joa3.12319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/07/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Parameters measured during implantable cardioverter defibrillator (ICD) implant also depend on bioelectrical properties of the myocardium. We aimed to explore their potential association with clinical outcomes in patients with single/dual-chamber ICD and cardiac resynchronization therapy defibrillator (CRT-D). METHODS In the framework of the Home Monitoring Expert Alliance, baseline electrical parameters for all implanted leads were compared by the occurrence of all-cause mortality, adjudicated ventricular arrhythmia (VA), and atrial high-rate episode lasting ≥24 hours (24 h AHRE). RESULTS In a cohort of 2976 patients (58.1% ICD) with a median follow-up of 25 months, event rates were 3.1/100 patient-years for all-cause mortality, 18.1/100 patient-years for VA, and 9.3/100 patient-years for 24 h AHRE. At univariate analysis, baseline shock impedance was consistently lower in groups with events than without, with a 40 Ω cutoff that better identified high-risk patients. However, at multivariable analysis, the adjusted-hazard ratios (HRs) lost statistical significance for any endpoint. Baseline atrial sensing amplitude during sinus rhythm was lower in patients with 24 h AHRE than in those without (2.45 [IQR: 1.65-3.85] vs 3.51 [IQR: 2.37-4.67] mV, P < .01). The adjusted HR for 24 h AHRE in patients with atrial sensing >1.5 mV vs those with values ≤1.5 mV was 0.52 (95% CI: 0.33-0.83), P = .006. CONCLUSIONS Although lower baseline shock impedance was observed in patients with events, the association lost statistical significance at multivariable analysis. Conversely, low sinus rhythm atrial sensing (≤1.5 mV) measured with standard transvenous leads could identify subjects at high risk of atrial arrhythmia.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Valeria Calvi
- Policlinico G. Rodolico, Az. O.U. Policlinico ‐ V. EmanueleCataniaItaly
| | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola‐MalpighiBolognaItaly
| | | | | | | | | | | | - Michele Manzo
- Azienda Ospedaliera Universitaria S.Giovanni di Dio e Ruggi D'AragonaSalernoItaly
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Vergara P, Solimene F, D'Onofrio A, Pisanò EC, Zanotto G, Pignalberi C, Iacopino S, Maglia G, Della Bella P, Calvi V, Curnis A, Senatore G, Biffi M, Capucci A, Parisi Q, Quartieri F, Caravati F, Giammaria M, Marini M, Rapacciuolo A, Manzo M, Giacopelli D, Gargaro A, Ricci RP. Are Atrial High-Rate Episodes Associated With Increased Risk of Ventricular Arrhythmias and Mortality? JACC Clin Electrophysiol 2019; 5:1197-1208. [PMID: 31648745 DOI: 10.1016/j.jacep.2019.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study evaluated the temporal association between atrial high-rate episodes (AHREs) and sustained ventricular arrhythmias (VAs) in a remotely monitored cohort with implantable cardioverter-defibrillators (ICD) with and/or without cardiac resynchronization therapy with a defibrillator (CRT-D). BACKGROUND Clinical relevance of AHREs in terms of VA rate and survival has not been outlined yet. METHODS This study analyzed data of patients with ICDs and CRT-Ds from the nationwide Home Monitoring Expert Alliance network. The cohort included 2,435 patients with a median follow-up of 25 months (interquartile range: 13 to 42 months) and age 70 years (range 61 to 77 years); 19.7% were women, 51.4% had coronary artery disease, and 45.2% had a CRT-D. There were 3,410 appropriate VA episodes; 498 (14.6%) were preceded by AHREs within 48 h; in 85.5% of this group, AHREs were still ongoing at episode onset. RESULTS In a longitudinal analysis, the odds ratios (ORs) of experiencing any VA in a 30-day interval with AHREs versus intervals without AHREs were 2.35 (95% confidence interval [CI]: 1.86 to 2.97; p < 0.001) for ventricular tachycardia (VT), 3.06 (95% CI: 2.35 to 3.99; p < 0.001) for fast VT, 1.84 (95% CI: 1.36 to 2.48; p < 0.001) for self-extinguishing ventricular fibrillation (VF), and 2.31 (95% CI: 1.17 to 4.57; p = 0.01) for VF. ORs decreased with increasing AHRE burden. Patients with AHREs 48 h before VAs were more likely to experience VA recurrences (adjusted hazard ratio [HR]: 1.78; 95% CI: 1.41 to 2.24; p < 0.001) and had higher overall mortality (HR: 2.67; 95% CI: 1.68 to 4.23; p < 0.001). CONCLUSIONS AHREs were not uncommon 48 h before VAs, which tended to be distributed around intervals with AHREs. Temporal connection between AHREs and VAs was a marker of increased risk of VA recurrence and a poorer prognosis.
Collapse
Affiliation(s)
- Pasquale Vergara
- Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy.
| | | | - Antonio D'Onofrio
- Electrophysiology and Cardiac, Pacing Unit, Ospedale Monaldi, Naples, Italy
| | - Ennio C Pisanò
- Cardiology, Department, Ospedale Vito Fazzi, Lecce, Italy
| | | | | | - Saverio Iacopino
- Arrhythmias and Cardiac Electrophysiology, Villa Maria Care & Research, Cotignola (RA), Italy
| | - Giampiero Maglia
- Electrophysiology, Cardiac Pacing, and Arrhythmias, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | - Paolo Della Bella
- Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
| | - Valeria Calvi
- Electrophysiology and Cardiac Pacing, Policlinico Vittorio Emanuele PO Ferrarotto, Catania, Italy
| | | | | | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Quintino Parisi
- Cardiology Department, Fondazione di Ricerca e Cura Giovanni Paolo II, Campobasso, Italy
| | - Fabio Quartieri
- Department of Interventional Cardiology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Fabrizio Caravati
- Department of Cardiology I, Ospedale di Circolo e Fond. Macchi, Varese, Italy
| | | | | | - Antonio Rapacciuolo
- UNINA Department of Advanced Biomedical Sciences, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Michele Manzo
- Department of Cardiology, Azienda Ospedaliera Universitaria S.Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Daniele Giacopelli
- Department of Clinical Research, BIOTRONIK Italia, Vimodrone (MI), Italy
| | - Alessio Gargaro
- Department of Clinical Research, BIOTRONIK Italia, Vimodrone (MI), Italy
| | - Renato P Ricci
- Department of Arrhythmias, CardioArrhythmology Center, Rome, Italy
| |
Collapse
|
10
|
Biffi M, D'Onofrio A, Pignalberi C, Pisanò EC, Iacopino S, Curnis A, Senatore G, Capucci A, Della Bella P, Calvi V, Zanotto G, Caravati F, Maglia G, Manzo M, Santamaria M, Ziacchi M, Lissoni F, Giacopelli D, Gargaro A, Solimene F. Rate-responsive pacing and atrial high rate episodes in cardiac resynchronization therapy patients: Is low heart rate the key? Clin Cardiol 2019; 42:820-828. [PMID: 31282000 PMCID: PMC6727874 DOI: 10.1002/clc.23227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/20/2019] [Accepted: 06/28/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The role of atrial rate-responsive (RR) pacing in cardiac resynchronization therapy (CRT) is unclear due to the favorable effect of rate lowering in systolic heart failure. Atrial high rate episodes (AHREs) in CRT recipients are particularly worrisome since they cause loss of CRT, beyond representing a stroke risk factor. HYPOTHESIS The presence of an association between RR and the incidence of AHREs. METHODS Daily remote transmissions from 836 CRT recipients were analyzed. AHREs were classified by duration: ≥15 minutes, ≥5 hours, and ≥ 24 hours. Variables possibly associated to AHREs were included in time-dependent proportional-hazard models, averaging over 30-day periods and adjusting for main baseline variables. RESULTS After a median follow-up of 23.9 (12.2-36.0) months, 507 (60.6%) patients experienced at least one 15-minute AHRE. RR function was programmed in 166 (19.8%) patients and was associated with an increased AHRE occurrence rate with hazard ratio (HR) ranging from 1.45 to 1.78 for the 3 cutoffs of episode duration. The negative effect of RR function was not observed in the subset of patients with low mean heart rate (<68 bpm). Higher mean heart rates increased AHRE risk (HR:1.02, P = .01), while CRT amount decreased it (HR:0.98, P < .01). The extent of atrial pacing did not predict AHRE occurrence. CONCLUSIONS RR pacing in CRT recipients is associated with increased AHRE occurrence, especially when an average heart rate > 68 bpm is attained.
Collapse
Affiliation(s)
- Mauro Biffi
- Policlinico Sant'Orsola‐MalpighiBolognaItaly
| | | | | | | | | | | | | | | | | | - Valeria Calvi
- Policlinico Vittorio Emanuele PO FerrarottoCataniaItaly
| | | | | | | | - Michele Manzo
- Azienda Ospedaliera Universitaria S.Giovanni di Dio e Ruggi D'AragonaSalernoItaly
| | | | | | | | | | | | | |
Collapse
|
11
|
Forleo GB, Solimene F, Pisanò EC, Zanotto G, Calvi V, Pignalberi C, Maglia G, Iacopino S, Quartieri F, Biffi M, Caravati F, Curnis A, Capucci A, Senatore G, Santamaria M, Della Bella P, Manzo M, Giacopelli D, Gargaro A, D'Onofrio A. Long-term outcomes after prophylactic ICD and CRT-D implantation in nonischemic patients: Analysis from a nationwide database of daily remote-monitoring transmissions. J Cardiovasc Electrophysiol 2019; 30:1626-1635. [PMID: 31165517 DOI: 10.1111/jce.14006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/09/2019] [Accepted: 05/27/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Clinical trials did not provide conclusive evidence concerning the benefit of prophylactic implantable cardioverter-defibrillators (ICDs) in patients with severe nonischemic cardiomyopathy (NICM). We aimed to compare incidence of appropriate sustained ventricular arrhythmia (SVA) and device therapy in ischemic cardiomyopathy (ICM) vs NICM ICD and/or cardiac resynchronization therapy (CRT-D) patients. METHODS AND RESULTS We analyzed remote-monitoring data from devices of the Home Monitoring Expert Alliance network. SVA recordings were adjudicated by three independent electrophysiologists. Our cohort included 1,946 patients who received either an ICD (55%) or a CRT-D (45%) for primary prevention of sudden cardiac death. Median (interquartile range) age was 70 (62-77) years, 81% were male, and 52% were in the ICM group. Patients were remotely monitored for a maximum follow-up of 5 years. The 5-year product-limit estimate of SVA incidence in patients with an ICD was 47.3% (95% confidence interval [CI], 41.0%-53.9%) in the ICM group and 44.7% (36.9%-53.3%) in the NICM group. In patients with a CRT-D, SVA incidence was 45.7% (37.3%-55.0%) in ICM patients and 49.2% (40.4%-58.7%) in NICM patients. The adjusted hazard ratio for SVA in the ICM vs NICM group was 0.96 (95% CI: 0.70-1.30, P = .77) in ICD patients and 0.85 (95% CI: 0.61-1.18, P = .34) in CRT-D patients. SVAs triggered appropriate device therapies with similar incidence in all groups. CONCLUSION In a large cohort of remotely monitored ICD and CRT-D recipients, SVA incidence did not significantly differ in ICM and NICM patients.
Collapse
Affiliation(s)
- Giovanni B Forleo
- Department of Cardiology, Azienda Ospedaliera - Polo Universitario - Luigi Sacco, Milan, Italy
| | - Francesco Solimene
- Department of Cardiac Electrophysiology, Clinica Montevergine, Mercogliano, Italy
| | - Ennio C Pisanò
- Department of Cardiology, Ospedale Vito Fazzi, Lecce, Italy
| | - Gabriele Zanotto
- Department of Cardiology, Ospedale Mater Salutis, Legnago, Italy
| | - Valeria Calvi
- Department of Cardiology, Policlinico Vittorio Emanuele PO Ferrarotto, Catania, Italy
| | - Carlo Pignalberi
- Department of Cardiology, Ospedale San Filippo Neri, Rome, Italy
| | - Giampiero Maglia
- Department of Cardiology, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | - Saverio Iacopino
- Department of Arrhythmology and Electrophysiology, Villa Maria Care & Research, Cotignola, Italy
| | - Fabio Quartieri
- Department of Cardiology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Mauro Biffi
- Department of Cardiology, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Fabrizio Caravati
- Department of Cardiology, Ospedale di Circolo e Fond. Macchi, Varese, Italy
| | - Antonio Curnis
- Department of Cardiology, Spedali Civili, Brescia, Italy
| | | | | | - Matteo Santamaria
- Department of Cardiology, Fondazione di Ricerca e Cura Giovanni Paolo II, Campobasso, Italy
| | - Paolo Della Bella
- Department of Cardiac Arrhythmology and Electrophysiology, Ospedale San Raffaele, Milano, Italy
| | - Michele Manzo
- Department of Cardiology, Azienda Ospedaliera Universitaria S.Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | | | - Alessio Gargaro
- Department of Clinical Research, BIOTRONIK Italia, Vimodrone, Italy
| | | |
Collapse
|
12
|
Zanotto G, D'Onofrio A, Della Bella P, Solimene F, Pisanò EC, Iacopino S, Dondina C, Giacopelli D, Gargaro A, Ricci RP. Organizational model and reactions to alerts in remote monitoring of cardiac implantable electronic devices: A survey from the Home Monitoring Expert Alliance project. Clin Cardiol 2018; 42:76-83. [PMID: 30421438 DOI: 10.1002/clc.23108] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This survey aimed to describe the organizational workflow of cardiac implantable electronic devices (CIEDs) remote monitoring (RM) service in ordinary practice. METHODS A questionnaire was designed for our purpose and completed by 49 sites participating to the Italian Home Monitoring Expert Alliance. RESULTS A dedicated organizational model for RM was set up for 86% of centers. The median RM team consisted of 2 (Interquartile range [IQR]: 1-3) physicians and 1 (IQR: 0-2) nurse. RM service was available in working hours and the median percentage of patients included was 100% (IQR: 10%-100%) for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) recipients and 5% (IQR:0%-30%) for pacemakers. In-office follow-up was performed every 12 and 6 months for pacemaker and ICD/CRT recipients, respectively. More than 90% of sites used to activate all technical alerts, with a prompt reaction in case of an out-of-range parameter. The threshold for atrial fibrillation (AF) daily burden notification in most cases ranged from 2.4 to 7.2 hours. All ventricular arrhythmias alerts were usually switched on: an inappropriate therapy or more than one appropriate episode triggered an urgent in-hospital visit. Concerning heart failure, low CRT percentage pacing alert was always used, while the other available notifications were less frequently switched on. CONCLUSIONS This survey showed that RM service was usually set up with a primary nursing model including on average two responsible physicians and one nurse and mainly offered to ICD/CRT patients. Technical, AF and ventricular arrhythmia alerts triggered prompt reactions, while heart failure related indexes were generally less applied.
Collapse
|
13
|
Russo V, Solimene F, Zanotto G, Pisanò EC, Della Bella P, Iacopino S, Pignalberi C, Calvi V, Maglia G, Quartieri F, Biffi M, Curnis A, Giacopelli D, Gargaro A, D'Onofrio A. Seasonal trend of ventricular arrhythmias in a nationwide remote monitoring database of implantable defibrillators and cardiac resynchronization devices. Int J Cardiol 2018; 275:104-106. [PMID: 30327133 DOI: 10.1016/j.ijcard.2018.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The occurrence of sustained ventricular arrhythmias (SVA) may be influenced by environmental factors. We aimed to investigate annual periodic trends of SVA from the intracardiac electrograms (IEGMs) stored in the implantable defibrillators (ICDs) or cardiac resynchronization therapy (CRT-D) recipients. METHODS Data from the Home Monitoring Expert Alliance project, a pooled repository of remote monitoring transmissions were analyzed. All IEGMs stored were independently adjudicated by three cardiac electrophysiologists. Periodicity of SVA was evaluated with Generalized Estimating Equations (GEE) models, including periodic terms depending on months in a year. RESULTS A total of 2936 ICD/CRT-D patients (median age 70 years, 79.6% male) were followed for a median period of 25[13-44] months. Most prevalent structural heart diseases were ischemic (50.8%) and idiopathic dilated (30.6%) cardiomyopathies. Overall, 942 (32.1%) patients experienced a total of 4824 SVA. At GEE analysis, we found a significant periodic component (p = 0.048) when considering both shocked and non-shocked episodes. SVA less frequently occurred in Junes and Julies (3.7 × 1000 patient-month). No evidence of significant periodicity was collected in the subgroup of ischemic patients. CONCLUSIONS In this RM-based cohort of ICD/CRT-T patients, we observed an annual periodicity of SVA occurrence, with a lower incidence in summer months.
Collapse
Affiliation(s)
- Vincenzo Russo
- University of Campania "Luigi Vanvitelli", Monaldi Hospital, Napoli, Italy.
| | | | | | | | | | | | | | - Valeria Calvi
- Policlinico Vittorio Emanuele PO Ferrarotto, Catania, Italy
| | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Napoli, Italy
| |
Collapse
|
14
|
Calvi V, Pisanò EC, Brieda M, Melissano D, Castaldi B, Guastaferro C, Nigro G, Madalosso M, Orsida D, Rovai N, Gargaro A, Capucci A. Atrioventricular Interval Extension Is Highly Efficient in Preventing Unnecessary Right Ventricular Pacing in Sinus Node Disease: A Randomized Cross-Over Study Versus Dual- to Atrial Single-Chamber Mode Switch. JACC Clin Electrophysiol 2018; 3:482-490. [PMID: 29759604 DOI: 10.1016/j.jacep.2016.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/20/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study sought to compare the Intrinsic Rhythm Support (IRSplus) and Ventricular Pace Suppress (VpS) in terms of right ventricular pacing percentage (VP %), mean atrioventricular interval (MAVI), atrial fibrillation, and cardiac volumes. BACKGROUND Modern pacemakers are provided with algorithms for reducing unnecessary ventricular pacing. These may be classified as: periodic search for intrinsic atrioventricular (AV) conduction prolonging the AV delay accordingly; or DDD-ADI mode switch. The IRSplus and VpS algorithms belong to the former and latter classes, respectively. METHODS Patients with sick sinus dysfunction without evidence of II/III degree AV block were 1:1 randomized to 6-month periods of either IRSplus or VpS, and then crossed over. Subsequent follow-ups were at the 12th month after randomization for device data retrieving, and at the 18th month with the same device programming for echocardiographic assessment. RESULTS A total of 230 patients (62% males, median age 75 years [interquartile range: 69 to 79 years]) were enrolled. At a linear mixed-model analysis with order of treatment and investigational sites as nested random effects, differences in VP% and MAVI reached statistical significance: VP% was 1% (0% to 11%) during IRSplus and 3% (0% to 26%) during VpS (p = 0.029); MAVI was 225 ms (198 to 253 ms) during IRSplus and 214 ms (188 to 240 ms) during VpS (p = 0.014). No differences were observed in atrial fibrillation burden and incidence, ejection fraction, and cardiac volumes. CONCLUSIONS Both IRSplus and VpS algorithms ensured VP% ≤3% in most patients with sinus node dysfunction and preserved AV conduction. The IRSplus was slightly more efficient in reducing VP% at the expense of a small MAVI increase, with statistical but clinically insignificant differences. (Ventricular Pace Suppression Versus Intrinsic Rhythm Support Study; NCT01528657).
Collapse
Affiliation(s)
- Valeria Calvi
- A.O.U. Policlinico Vittorio Emanuele, PO Ferrarotto, Catania, Italy.
| | | | - Marco Brieda
- Santa Maria Degli Angeli Hospital, Pordenone, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Rovaris G, Solimene F, D'Onofrio A, Zanotto G, Ricci RP, Mazzella T, Iacopino S, Della Bella P, Maglia G, Senatore G, Quartieri F, Biffi M, Curnis A, Calvi V, Rapacciuolo A, Santamaria M, Capucci A, Giammaria M, Campana A, Caravati F, Giacopelli D, Gargaro A, Pisanò EC. Does the CHA 2DS 2-VASc score reliably predict atrial arrhythmias? Analysis of a nationwide database of remote monitoring data transmitted daily from cardiac implantable electronic devices. Heart Rhythm 2018; 15:971-979. [PMID: 29477974 DOI: 10.1016/j.hrthm.2018.02.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND CHA2DS2-VASc is a validated score for predicting stroke in patients with atrial fibrillation (AF). OBJECTIVE The purpose of this study was to assess whether the CHA2DS2-VASc score can predict new-onset AF in a cohort of patients with a cardiac implantable electronic device (CIED) followed with remote monitoring. METHODS Using the database of the Home Monitoring Expert Alliance project, we selected 2410 patients with no documented AF who had received a CIED with diagnostics on atrial high rate episodes (AHREs). The primary endpoint was time to first day with cumulative AHRE burden ≥15 minutes, 5 hours, 24 hours, and ≥7 consecutive days. RESULTS During a median duration of 24.1(11.5-42.9) months, the incidence of AHRE increased with increasing CHA2DS2-VASc. At 6 years, occurrence of ≥15-minute AHRE was 80.2% (CHA2DS2-VASc ≤1) vs 93.7% (CHA2DS2-VASc ≥5), whereas ≥5-hour AHRE incidence was 68.4% (CHA2DS2-VASc ≤1) vs 92.5% (CHA2DS2-VASc ≥5). Occurrence of ≥24-hour and ≥7-day AHREs also increased with increasing CHA2DS2-VASc: 9.1% and 3.9% (CHA2DS2-VASc ≤1) vs 40.4% and 28.7% (CHA2DS2-VASc ≥5), respectively. Adjusted hazard ratio for unitary CHA2DS2-VASc increase ranged from 1.09 (confidence interval 1.04-1.14; P <.001) with AHRE burden ≥15 minutes to 1.26 (confidence interval 1.11-1.42; P <.001) with AHRE burden ≥7 days. At receiver operating curve analysis, CHA2DS2-VASc ≥2 was estimated to predict persistent forms of AHREs with 95.8% sensitivity but 11.7% specificity at 3 years. CHA2DS2-VASc ≥5 had 77.0% specificity but 34.6% sensitivity. CONCLUSION In a CIED population with no previous diagnosis of clinical AF, AHRE incidence increased with increasing CHA2DS2-VASc score. The association was stronger with longer AHREs, but the accuracy of CHA2DS2-VASc as AHRE predictor was moderate.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Saverio Iacopino
- Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Valeria Calvi
- Policlinico Vittorio Emanuele PO Ferrarotto, Catania, Italy
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|