Abstract 18147: Association of the First Occurrence of Atrial Fibrillation With Short-Term ICD Therapy and Heart Failure Exacerbation
Background: Atrial fibrillation (AF) predicts inappropriate therapy and mortality in patients (pts) with implantable cardioverter defibrillators (ICDs). The short term effects of AF in pts with ICDs are not known. We sought to determine if AF burden affected 30 day morbidity as defined by heart failure (HF) exacerbations and ICD therapy.
Methods: Pts enrolled in the LATITUDE home monitoring system were analyzed. Devices with greater than 1% AF during a 30-day period were included and divided into deciles based on the AF burden. The deciles were compared on number of ICD shocks, blood pressure and heart rate measures, and 6 HF symptom questions from the LATITUDE monitoring system. Symptom questions were scored as “-1” for improved, “0” for same, and “1” for worsened.
Results: 4258 pts were identified with an AF burden >1%. Of those, 3197 had heart failure observations recorded before and after the AF episode. Compared with before the 1st AF episode, in the month following, pts had a worsened activity level (P<0.001), systolic blood pressure (P<0.001), and heart rate variability (P=0.005). Pts also reported worsened dizziness (P<0.001), edema (P=0.006), exercise capacity (P=0.01), orthopnea (P<0.001), and more episodes of nocturnal dyspnea (P<0.001) The trend for nocturnal dyspnea and fatigue was significant across AF burden deciles (Figure). There was no difference in the mean number of shocks after the analyzed month of AF.
Conclusion: Short term AF burden is predictive of worsened HF symptoms but not ICD shocks.
- © 2013 by American Heart Association, Inc.