Document Detail


Atrial fibrillation is under-recognized in chronic heart failure: insights from a heart failure cohort treated with cardiac resynchronization therapy.
MedLine Citation:
PMID:  19648586     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Jane C Caldwell; Hussain Contractor; Sanjiv Petkar; Razwan Ali; Bernard Clarke; Clifford J Garratt; Ludwig Neyses; Mamas A Mamas
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-08-01
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  11     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-02     Completed Date:  2010-01-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  1295-300     Citation Subset:  IM    
Affiliation:
Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
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MeSH Terms
Descriptor/Qualifier:
Aged
Atrial Fibrillation / diagnosis*,  epidemiology*
Cardiac Pacing, Artificial / utilization*
Cohort Studies
Comorbidity
False Negative Reactions
Female
Great Britain / epidemiology
Heart Failure / diagnosis,  epidemiology*,  prevention & control*
Humans
Incidence
Male
Reproducibility of Results
Retrospective Studies
Risk Assessment
Risk Factors
Sensitivity and Specificity
Treatment Outcome
Comments/Corrections
Comment In:
Europace. 2009 Oct;11(10):1257-9   [PMID:  19797141 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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