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KMID : 0368120230530070483
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Korean Circulation Journal
2023 Volume.53 No. 7 p.483 ~ p.496
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Clinical Implications of Device-Detected Atrial Fibrillation in Cardiac Resynchronization Therapy
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Yoon Min-Jae
Oh Jae-Won
Chun Kyeong-Hyeon
Yu Hee-Tae
Lee Chan-Joo
Kim Tae-Hoon
Pak Hui-Nam
Lee Moon-Hyoung
Joung Bo-Young
Kang Seok-Min
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Abstract
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Background and Objectives: Atrial fibrillation (AF) is associated with decreased cardiac resynchronization therapy (CRT) benefits compared to sinus rhythm (SR). Effective biventricular (BiV) pacing is a determinant of CRT success, but AF can interfere with adequate BiV pacing and affect clinical outcomes. We investigated the effect of device-detected AF on clinical outcomes and optimal BiV pacing in patients with heart failure (HF) treated with CRT.
Methods: We retrospectively analyzed 174 patients who underwent CRT implantation between 2012 and 2019 at a tertiary center. The optimal BiV pacing percentage was defined as ≥98%. Device-detected AF was defined as an atrial high-rate episode ≥180 beats per minute lasting more than 6 minutes during the follow-up period. We stratified the patients without preexisting AF at pre-implantation into device-detected AF and no-AF groups.
Results: A total of 120 patients did not show preexisting AF at pre-implantation, and 54 had AF. Among these 120 patients, 19 (15.8%) showed device-detected AF during a median follow-up of 25.1 months. The proportion of optimal BiV pacing was significantly lower in the device-detected AF group than in the no-AF group (42.1% vs. 75.2%, p=0.009). The device-detected AF group had a higher incidence of HF hospitalization, cardiovascular death, and all-cause death than the no-AF group. The device-detected AF and previous AF groups showed no significant differences regarding the percentage of BiV pacing and clinical outcomes.
Conclusions: For HF patients implanted with CRT, device-detected AF was associated with lower optimal BiV pacing and worse clinical outcomes than no-AF.
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KEYWORD
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Cardiac resynchronization therapy, Atrial fibrillation, Heart failure
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