title: Device-detected atrial tachyarrhythmias predict adverse outcome in real-world patients with implantable biventricular defibrillators.
abstract: OBJECTIVE
  The purpose of this analysis was to evaluate the correlation between atrial tachycardia (AT) or atrial fibrillation (AF) and clinical outcomes in heart failure (HF) patients implanted with a cardiac resynchronization therapy defibrillator (CRT-D).
  
  
  BACKGROUND
  In HF patients, AT and AF have high prevalence and are associated with compromised hemodynamic function.
  
  
  METHODS
  Forty-four Italian cardiological centers followed up 1,193 patients who received a CRT-D according to current guidelines for advanced HF, New York Heart Association functional class ≥ II, left ventricular ejection fraction ≤ 35%, and QRS complex ≥ 120 ms. All patients were in sinus rhythm at implant.
  
  
  RESULTS
  During a median follow-up period of 13 months, AT/AF >10 min occurred in 361 of 1,193 (30%) patients. The composite end point (deaths or HF hospitalizations) occurred in 174 of 1,193 (14.6%). Multivariate time-dependent Cox regression analyses showed that composite end point risk was higher among patients with device-detected AT/AF (hazard ratio [HR]: 2.16, p = 0.032), New York Heart Association functional class III or IV compared with II (HR: 2.09, p = 0.002), and absence of beta-blockers (HR: 1.36, p = 0.036). Furthermore, the composite end point risk was inversely associated with left ventricular ejection fraction (HR: 1.04, p = 0.045), increasing by a factor of 4% for each 1% decrease in left ventricular ejection fraction.
  
  
  CONCLUSIONS
  In HF patients with CRT-D, device-detected AT/AF is associated with a worse prognosis. Continuous device diagnostics monitoring and Web-based alerts may inform the physician of AT/AF occurrences and identify patients at risk of cardiac deterioration or patients with suboptimal rate or rhythm control. (Italian ClinicalService Project; NCT01007474).
authors.affiliation: Institute of Cardiology, San Filippo Neri Hospital, Rome, Italy. m.santini@rmnet.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gasparini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.forename: Domenico
authors.initials: D
authors.lastname: Catanzariti
authors.forename: Giulio
authors.initials: G
authors.lastname: Molon
authors.forename: Giovanni Luca
authors.initials: GL
authors.lastname: Botto
authors.forename: Laura
authors.initials: L
authors.lastname: La Rocca
authors.forename: Andrea
authors.initials: A
authors.lastname: Grammatico
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D017147:Defibrillators, Implantable; D018450:Disease Progression; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D011379:Prognosis; D013318:Stroke Volume; D013612:Tachycardia, Ectopic Atrial / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D013997:Time Factors; D016277:Ventricular Function, Left