Author + information
- Received February 26, 2018
- Revision received May 31, 2018
- Accepted June 7, 2018
- Published online September 17, 2018.
- Ikutaro Nakajima, MDa,b,
- Takashi Noda, MD, PhDa,∗ (, )
- Hideaki Kanzaski, MD, PhDa,
- Tsukasa Kamakura, MD, PhDa,
- Mitsuru Wada, MDa,
- Kohei Ishibashi, MD, PhDa,
- Yuko Inoue, MD, PhDa,
- Koji Miyamoto, MD, PhDa,
- Hideo Okamura, MD, PhDa,
- Satoshi Nagase, MD, PhDa,
- Takeshi Aiba, MD, PhDa,
- Shiro Kamakura, MD, PhDa,
- Teruo Noguchi, MD, PhDa,
- Satoshi Yasuda, MD, PhDa,
- Yoshihiro J. Akashi, MD, PhDb and
- Kengo F. Kusano, MD, PhDa
- aDivision of Cardiology, National Cerebral and Cardiovascular Center Japan, Suita Osaka, Japan
- bDivision of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- ↵∗Address for correspondence:
Dr. Takashi Noda, Division of Cardiology, National Cerebral and Cardiovascular Center Japan, 5-7-1 Fujishiro-dai, Suita, Osakato 565-8565, Japan.
Objectives This study aimed to clarify the clinical impact of transient atrial fibrillation (AF) attacks themselves and the efficacy of cardiac resynchronization therapy (CRT) in patients with intermittent AF.
Background The benefit of CRT in patients with intermittent AF, especially the effect of the AF attacks themselves, remains unclear.
Methods Among our cohort of 269 consecutive CRT patients, we compared the percent of biventricular pacing (BIVP%) and other clinical characteristics between patients with intermittent AF and those with sinus rhythm (SR).
Results During a median follow-up of 942 days (interquartile range: 379 to 1,464 days) a total of 22 patients, including 59% of CRT responders, developed heart failure (HF) due to a transient AF attack itself, and that accounted for 21% of all HF events. The BIVP% during the AF attacks was significantly lower than that during SR (p < 0.05). When compared to the SR groups, patients with intermittent AF had a significantly higher risk of developing HF or death (hazard ratio: 2.2; 95% confidence interval: 1.3 to 3.8). However, the patients who received a BIVP% of ≥90% during AF attacks were comparable to those with SR (hazard ratio: 1.2; 95% confidence interval: 0.4 to 3.0).
Conclusions A substantial number of patients developed HF due to transient AF attacks themselves even in the CRT responders, and the reason was mainly due to the loss of the BIVP%.
- atrial fibrillation
- biventricular pacing rate
- cardiac resynchronization therapy
- clinical outcome
- heart failure
This study was supported by the intramural research fund (25-4-7, Dr. Kusano) for cardiovascular diseases of the National Cerebral and Cardiovascular Center, and trust research and joint research funds of Medtronic Japan Co., Ltd. Drs. Noda and Kusano have received personal fees from Medtronic Japan Co., Ltd. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 26, 2018.
- Revision received May 31, 2018.
- Accepted June 7, 2018.
- 2018 American College of Cardiology Foundation
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