Temporal Association of Atrial Fibrillation With Cardiac Implanted Electronic Device Detected Heart Failure Status

Abstract

Objectives: This study sought to investigate the temporal association between changes in physiologic heart failure (HF) sensors, atrial fibrillation (AF) progression, and clinical HF in patients with cardiac resynchronization therapy implantable defibrillators (CRT-D) designed to monitor AF and HF daily.

Background: AF is a common comorbidity in HF; however, it is unclear if HF triggers AF, or vice-versa. Current implantable cardiac devices have sensors capable of quantifying HF status, which permits a greater understanding of the impact of AF on HF status and may help guide treatment.

Methods: The MultiSENSE (Multisensor Chronic Evaluation in Ambulatory Heart Failure Patients) study collected multiple sensor data indicative of HF status in patients with CRT-D followed for up to 12 months. Patients were grouped according to their longest daily AF burden: 1) at least 24 hours of AF (HIGH AF); 2) between 6 minutes and 24 hours (MID AF); and 3) <6 minutes (NO AF). Sensor data were aligned to the first qualifying AF event or a randomly selected day for patients in the NO AF group.

Results: Among 869 patients with daily AF data available, 98 patients had HIGH AF, 141 patients MID AF, and 630 patients NO AF. At baseline, history of AF, N-terminal pro hormone B-type natriuretic peptide and device-measured S3 were associated with development of AF. HeartLogic index increased before AF onset (Δ HeartLogic = 9.83 ± 2.49; P < 0.001). Multivariable time-dependent Cox regression showed an increased risk for HF events following a 24-hour AF episode compared with no 24-hour AF (hazard ratio: 1.96; 95% confidence interval: 1.03-3.74).

Conclusions: Device-measured HF indicators worsened before AF onset, whereas clinical HF deterioration only became apparent after AF occurred. Thus, the sensitivity of methods to ascertain AF and HF status appear to influence the direction of perceived causality. (Multisensor Chronic Evaluation in Ambulatory Heart Failure Patients [MultiSENSE]; NCT01128166).

Keywords: CRT; ICD; atrial fibrillation; decompensation; heart failure; heart sounds.

Conflict of interest statement

Funding Support and Author Disclosures The MultiSENSE study was sponsored by the Boston Scientific Corporation. Dr Capucci has received honoraria from Abbott, Bayer, Boehringer Ingelheim, Boston Scientific, Pfizer, and Sorin Italia. Dr Wong holds a McMaster University Department of Medicine Early-Career Research Award; and has received speaking fees from Biosense Webster. Dr Gold has been a consultant and has received research grants from Boston Scientific and Medtronic. Dr Boehmer has been a consultant for Boston Scientific. Drs Ahmed, Zhang, Kwan, Thakur, and Jones are employees of Boston Scientific. Dr Healey has received research grants and speaking fees from Bristol Myers Squibb and Pfizer, Servier, Medtronic, and Boston Scientific; and has been a consultant for Boston Scientific.

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.