title: Prediction of atrial fibrillation in patients with an implantable cardioverter-defibrillator and heart failure.
abstract: OBJECTIVE
  Heart failure and atrial fibrillation (AF) frequently coexist and AF worsens heart failure prognosis. Device-based diagnostics derived from implantable cardioverter-defibrillator (ICD) interrogation provide an accurate method for detecting AF episodes. This study sought to determine clinical and echocardiographic predictors of AF occurrence, including an index of total atrial conduction time derived by tissue Doppler imaging (PA-TDI duration), in patients with heart failure. Moreover, the role of PA-TDI duration on the prediction of AF occurrence in subgroups of patients with and without history of AF was explored.
  
  
  RESULTS
  A cohort of 495 heart failure patients who underwent ICD implantation was studied. Baseline echocardiographic parameters of systolic and diastolic function were evaluated together with clinical parameters. Furthermore, PA-TDI duration was measured. All patients were prospectively followed up after ICD implantation for AF occurrence detected by ICD interrogation. A total of 142 (29%) patients experienced AF over a follow-up period of 16.4 ± 11.2 months. PA-TDI duration was longer in patients with AF occurrence when compared with patients without AF occurrence (154 ± 27 vs. 135 ± 24 ms, P < 0.001). On Cox-multivariable analysis, female gender [hazard ratio = 1.60; 95% confidence intervals (CI) = 1.09-2.35; P = 0.017], history of AF (hazard ratio = 2.22; 95% CI, 1.51-3.27; P < 0.001), and PA-TDI duration (hazard ratio = 1.27; 95% CI, 1.13-1.42; P < 0.001) were independent predictors of AF occurrence. In the subgroups of patients with and without history of AF, PA-TDI duration remained an independent predictor of AF occurrence.
  
  
  CONCLUSIONS
  PA-TDI duration may be useful to risk-stratify for AF occurrence in heart failure patients with and without a history of AF.
authors.affiliation: Departments of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. m.bertini@lumc.nl
authors.forename: Matteo
authors.initials: M
authors.lastname: Bertini
authors.forename: C Jan Willem
authors.initials: CJ
authors.lastname: Borleffs
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Arnold C T
authors.initials: AC
authors.lastname: Ng
authors.forename: Sebastiaan R D
authors.initials: SR
authors.lastname: Piers
authors.forename: Miriam
authors.initials: M
authors.lastname: Shanks
authors.forename: M Louisa
authors.initials: ML
authors.lastname: Antoni
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Nico R L
authors.initials: NR
authors.lastname: Van de Veire
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D016001:Confidence Intervals; D017147:Defibrillators, Implantable; D018450:Disease Progression; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D013997:Time Factors; D018608:Ultrasonography, Doppler