BACKGROUND In heart failure (HF) patients, atrial fibrillation (AF) is associated with a worse prognosis. Implantable cardioverter-defibrillator (ICD) diagnostics allow continuous monitoring of AF and are equipped with algorithms for HF moni-toring. OBJECTIVE We evaluated the association between the values of the multisensor HF HeartLogic index and the incidence of AF, and as-sessed the performance of the index in detecting follow-up periods of significantly increased AF risk. METHODS The HeartLogic feature was activated in 568 ICD pa-tients. Median follow-up was 25 months [25th-75th percentile (15-35)]. The HeartLogic algorithm calculates a daily HF index and identifies periods of IN-alert state on the basis of a configurable threshold. The endpoints were daily AF burden >= 5 minutes, >= 6 hours, and >= 23 hours. RESULTS The HeartLogic index crossed the threshold value 1200 times. AF burden >= 5 minutes/day was documented in 183 patients (32%), >= 6 hours/day in 118 patients (21%), and >= 23 hours/day in 89 patients (16%). The weekly time of IN-alert state was independently associated with AF burden >= 5 minutes/day (hazard ratio [HR] 1.95; 95% confidence interval [CI] 1.22- 3.13; P 5 .005), >= 6 hours/day (HR 2.66; 95% CI 1.60-4.44; P <.001), and >= 23 hours/day (HR 3.32; 95% CI 1.83-6.02; P <.001), after correction for baseline confounders. Comparison of the episode rates in the IN-alert state with those in the OUT -of-alert state yielded HR ranging from 1.57 to 3.11 for AF burden from >= 5 minutes to >= 23 hours. CONCLUSIONS The HeartLogic alert state was independently asso-ciated with AF occurrence. The intervals of time defined by the algo-rithm as periods of increased risk of HF allow risk stratification of AF according to various thresholds of daily burden.
Implantable defibrillator-detected heart failure status predicts atrial fibrillation occurrence
Santobuono, Vincenzo Ezio;
2022-01-01
Abstract
BACKGROUND In heart failure (HF) patients, atrial fibrillation (AF) is associated with a worse prognosis. Implantable cardioverter-defibrillator (ICD) diagnostics allow continuous monitoring of AF and are equipped with algorithms for HF moni-toring. OBJECTIVE We evaluated the association between the values of the multisensor HF HeartLogic index and the incidence of AF, and as-sessed the performance of the index in detecting follow-up periods of significantly increased AF risk. METHODS The HeartLogic feature was activated in 568 ICD pa-tients. Median follow-up was 25 months [25th-75th percentile (15-35)]. The HeartLogic algorithm calculates a daily HF index and identifies periods of IN-alert state on the basis of a configurable threshold. The endpoints were daily AF burden >= 5 minutes, >= 6 hours, and >= 23 hours. RESULTS The HeartLogic index crossed the threshold value 1200 times. AF burden >= 5 minutes/day was documented in 183 patients (32%), >= 6 hours/day in 118 patients (21%), and >= 23 hours/day in 89 patients (16%). The weekly time of IN-alert state was independently associated with AF burden >= 5 minutes/day (hazard ratio [HR] 1.95; 95% confidence interval [CI] 1.22- 3.13; P 5 .005), >= 6 hours/day (HR 2.66; 95% CI 1.60-4.44; P <.001), and >= 23 hours/day (HR 3.32; 95% CI 1.83-6.02; P <.001), after correction for baseline confounders. Comparison of the episode rates in the IN-alert state with those in the OUT -of-alert state yielded HR ranging from 1.57 to 3.11 for AF burden from >= 5 minutes to >= 23 hours. CONCLUSIONS The HeartLogic alert state was independently asso-ciated with AF occurrence. The intervals of time defined by the algo-rithm as periods of increased risk of HF allow risk stratification of AF according to various thresholds of daily burden.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
