TY - JOUR
T1 - Estimating the incidence of atrial fibrillation in single-chamber implantable cardioverter defibrillator patients
AU - Zweibel, Steven
AU - Cronin, Edmond M.
AU - Schloss, Edward J.
AU - Auricchio, Angelo
AU - Kurita, Takashi
AU - Sterns, Laurence D.
AU - Gerritse, Bart
AU - Lexcen, Daniel R.
AU - Cheng, Alan
N1 - Funding Information:
informationThe PainFree SST Trial was sponsored in its entirety by Medtronic plc.We would like to acknowledge all the PainFree SST trial investigators for their participation and contributions to the study. The authors would also like to acknowledge the contributions of Koen J.P. Verhees, PhD, an employee of Medtronic, for his editorial support and the critical appraisal of this manuscript.
Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2019/2
Y1 - 2019/2
N2 - Background: Atrial arrhythmias are associated with major adverse cardiovascular events. Recent reports among implantable cardioverter defibrillator (ICD) patients have demonstrated a high prevalence of atrial fibrillation (AF), predominantly in dual-chamber recipients. AF incidence among patients with single-chamber systems (approximately 50% of all ICDs) is currently unknown. The objective was to estimate the prevalence of new-onset AF among single-chamber ICD patients by observing the rates of new atrial tachycardia (AT)/AF among a propensity scoring matched cohort of dual-chamber ICD patients from the PainFree SmartShock technology study, to better inform screening initiatives. Methods: Among 2770 patients enrolled, 1862 single-chamber, dual-chamber, and cardiac resynchronization therapy subjects with no prior history of atrial tachyarrhythmias were included. Daily AT/AF burden was estimated using a propensity score weighted model against data from dual-chamber ICDs. Results: Over 22 ± 9 months of follow-up, the estimated incidence of AT/AF—lasting at least 6 min, 6 h, and 24 h per day —in the single-chamber cohort was 22.0, 9.8, and 6.3%, whereas among dual-chamber patients, the prevalence was 26.6, 13.1, and 7.1%, respectively. Initiation of oral anticoagulation was estimated to occur in 9.8% of the propensity matched single-chamber cohort, which was higher than the actual observed rate of 6.0%. Stroke and transient ischemic attack occurred at low rates in all device subgroups. Conclusions: Atrial arrhythmias occur frequently, and significant underutilization of anticoagulation is suggested in single-chamber ICD recipients. Routine screening for AF should be considered among single-chamber ICD recipients.
AB - Background: Atrial arrhythmias are associated with major adverse cardiovascular events. Recent reports among implantable cardioverter defibrillator (ICD) patients have demonstrated a high prevalence of atrial fibrillation (AF), predominantly in dual-chamber recipients. AF incidence among patients with single-chamber systems (approximately 50% of all ICDs) is currently unknown. The objective was to estimate the prevalence of new-onset AF among single-chamber ICD patients by observing the rates of new atrial tachycardia (AT)/AF among a propensity scoring matched cohort of dual-chamber ICD patients from the PainFree SmartShock technology study, to better inform screening initiatives. Methods: Among 2770 patients enrolled, 1862 single-chamber, dual-chamber, and cardiac resynchronization therapy subjects with no prior history of atrial tachyarrhythmias were included. Daily AT/AF burden was estimated using a propensity score weighted model against data from dual-chamber ICDs. Results: Over 22 ± 9 months of follow-up, the estimated incidence of AT/AF—lasting at least 6 min, 6 h, and 24 h per day —in the single-chamber cohort was 22.0, 9.8, and 6.3%, whereas among dual-chamber patients, the prevalence was 26.6, 13.1, and 7.1%, respectively. Initiation of oral anticoagulation was estimated to occur in 9.8% of the propensity matched single-chamber cohort, which was higher than the actual observed rate of 6.0%. Stroke and transient ischemic attack occurred at low rates in all device subgroups. Conclusions: Atrial arrhythmias occur frequently, and significant underutilization of anticoagulation is suggested in single-chamber ICD recipients. Routine screening for AF should be considered among single-chamber ICD recipients.
KW - atrial fibrillation
KW - atrial tachyarrhythmia
KW - cardiac implantable electronic device
KW - cardiac resynchronization therapy
KW - implantable cardioverter defibrillator
KW - stroke
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U2 - 10.1111/pace.13555
DO - 10.1111/pace.13555
M3 - Article
C2 - 30478983
AN - SCOPUS:85058628491
SN - 0147-8389
VL - 42
SP - 132
EP - 138
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
IS - 2
ER -