Author + information
- Received January 24, 2019
- Revision received June 28, 2019
- Accepted June 28, 2019
- Published online October 21, 2019.
- Pasquale Vergara, MD, PhDa,∗ (, )
- Francesco Solimene, MDb,
- Antonio D'Onofrio, MDc,
- Ennio C. Pisanò, MDd,
- Gabriele Zanotto, MDe,
- Carlo Pignalberi, MDf,
- Saverio Iacopino, MDg,
- Giampiero Maglia, MDh,
- Paolo Della Bella, MDa,
- Valeria Calvi, MDi,
- Antonio Curnis, MDj,
- Gaetano Senatore, MDk,
- Mauro Biffi, MDl,
- Alessandro Capucci, MDm,
- Quintino Parisi, MDn,
- Fabio Quartieri, MDo,
- Fabrizio Caravati, MDp,
- Massimo Giammaria, MDq,
- Massimiliano Marini, MDr,
- Antonio Rapacciuolo, MD, PhDs,
- Michele Manzo, MDt,
- Daniele Giacopelli, MScu,
- Alessio Gargaro, MScu and
- Renato P. Ricci, MDv
- aArrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
- bElectrophysiology Lab, Clinica Montevergine, Mercogliano (AV), Italy
- cElectrophysiology and Cardiac, Pacing Unit, Ospedale Monaldi, Naples, Italy
- dCardiology, Department, Ospedale Vito Fazzi, Lecce, Italy
- eCardiology Department, Ospedale Mater Salutis, Legnago, Italy
- fCardiology Department, Ospedale San Filippo Neri, Rome, Italy
- gArrhythmias and Cardiac Electrophysiology, Villa Maria Care & Research, Cotignola (RA), Italy
- hElectrophysiology, Cardiac Pacing, and Arrhythmias, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
- iElectrophysiology and Cardiac Pacing, Policlinico Vittorio Emanuele PO Ferrarotto, Catania, Italy
- jCardiology Division, Spedali Civili, Brescia, Italy
- kCardiology Division, Ospedale di Ciriè, Ciriè (TO), Italy
- lInstitute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
- mCardiology Department, Ospedali Riuniti, Ancona, Italy
- nCardiology Department, Fondazione di Ricerca e Cura Giovanni Paolo II, Campobasso, Italy
- oDepartment of Interventional Cardiology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
- pDepartment of Cardiology I, Ospedale di Circolo e Fond. Macchi, Varese, Italy
- qDepartment of Cardiology, Ospedale Maria Vittoria, Torino, Italy
- rDepartment of Cardiology, Ospedale Santa Chiara, Trento, Italy
- sUNINA Department of Advanced Biomedical Sciences, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
- tDepartment of Cardiology, Azienda Ospedaliera Universitaria S.Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
- uDepartment of Clinical Research, BIOTRONIK Italia, Vimodrone (MI), Italy
- vDepartment of Arrhythmias, CardioArrhythmology Center, Rome, Italy
- ↵∗Address for correspondence:
Dr. Pasquale Vergara, Arrhythmia Unit and Electrophysiology Laboratory, Department of Cardiology and Cardiothoracic Surgery, Ospedale S. Raffaele, Milano, Italy.
Objectives This study evaluated the temporal association between atrial high-rate episodes (AHREs) and sustained ventricular arrhythmias (VAs) in a remotely monitored cohort with implantable cardioverter-defibrillators (ICD) with and/or without cardiac resynchronization therapy with a defibrillator (CRT-D).
Background Clinical relevance of AHREs in terms of VA rate and survival has not been outlined yet.
Methods This study analyzed data of patients with ICDs and CRT-Ds from the nationwide Home Monitoring Expert Alliance network. The cohort included 2,435 patients with a median follow-up of 25 months (interquartile range: 13 to 42 months) and age 70 years (range 61 to 77 years); 19.7% were women, 51.4% had coronary artery disease, and 45.2% had a CRT-D. There were 3,410 appropriate VA episodes; 498 (14.6%) were preceded by AHREs within 48 h; in 85.5% of this group, AHREs were still ongoing at episode onset.
Results In a longitudinal analysis, the odds ratios (ORs) of experiencing any VA in a 30-day interval with AHREs versus intervals without AHREs were 2.35 (95% confidence interval [CI]: 1.86 to 2.97; p < 0.001) for ventricular tachycardia (VT), 3.06 (95% CI: 2.35 to 3.99; p < 0.001) for fast VT, 1.84 (95% CI: 1.36 to 2.48; p < 0.001) for self-extinguishing ventricular fibrillation (VF), and 2.31 (95% CI: 1.17 to 4.57; p = 0.01) for VF. ORs decreased with increasing AHRE burden. Patients with AHREs 48 h before VAs were more likely to experience VA recurrences (adjusted hazard ratio [HR]: 1.78; 95% CI: 1.41 to 2.24; p < 0.001) and had higher overall mortality (HR: 2.67; 95% CI: 1.68 to 4.23; p < 0.001).
Conclusions AHREs were not uncommon 48 h before VAs, which tended to be distributed around intervals with AHREs. Temporal connection between AHREs and VAs was a marker of increased risk of VA recurrence and a poorer prognosis.
- atrial fibrillation
- atrial high rate episodes
- implantable cardioverter-defibrillator
- ventricular arrhythmias
- ventricular tachycardia
Dr. Vergara has been a consultant for Biosense Webster and Boston Scientific. Dr. Della Bella has received consultancy fees from Abbott, Biosense Webster, and Boston Scientific. Dr. Ricci has received consultancy fees from Medtronic and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 January 24, 2019.
- Revision received June 28, 2019.
- Accepted June 28, 2019.
- 2019 American College of Cardiology Foundation
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