Estimating the incidence of atrial fibrillation in single-chamber implantable cardioverter defibrillator patients

Steven Zweibel, Edmond M. Cronin, Edward J. Schloss, Angelo Auricchio, Takashi Kurita, Laurence D. Sterns, Bart Gerritse, Daniel R. Lexcen, Alan Cheng

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)132-138
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume42
Issue number2
DOIs
StatePublished - Feb 1 2019

Keywords

  • atrial fibrillation
  • atrial tachyarrhythmia
  • cardiac implantable electronic device
  • cardiac resynchronization therapy
  • implantable cardioverter defibrillator
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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