Europace Advance Access originally published online on August 1, 2009
Europace 2009 11(10):1295-1300; doi:10.1093/europace/eup201
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Atrial Fibrillation - clinical issues
Atrial fibrillation is under-recognized in chronic heart failure: insights from a heart failure cohort treated with cardiac resynchronization therapy
1 Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; 2 Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9WL, UK
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 results: An 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).
Conclusion: Analysis 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.
Key Words: Atrial fibrillation, Heart failure, CRT
* Corresponding author. Tel: +44 161 275 5672, Fax: +44 161 275 5669, Email: mamasmamas1{at}yahoo.co.uk
Joint first authors who contributed equally to the manuscript.
Manuscript submitted 18 April 2009. Accepted after revision 30 June 2009.
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Europace 2009 11: 1257-1259.[Full Text]
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  R. Pisters, C. B. de Vos, R. Dennert, and H. J. Crijns Undetected paroxysmal atrial fibrillation in chronic heart failure patients: is it clinically relevant to catch the atrial phantom? Europace, October 1, 2009; 11(10): 1257 - 1259. [Full Text] [PDF]
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