P1636Incidence and predictors of atrial arrhythmias in patients with a dual chamber implantable cardioverter-defibrillator followed by remote monitoring

Abstract

Background: Patients with dual chamber implantable cardioverter-defibrillator (DR-ICD) are at risk of developing atrial arrhythmias because of the increased rate of ventricular pacing or the progression of heart failure. Atrial arrhythmia burden (AB) can be monitored continuously by Remote Monitoring (RM) in order to detect early changes associated with patient risks, and optimize medical therapy. Purpose: To evaluate the outcome of patients with DR-ICDs and active RM. Methods: A total of 283 patients with 91,632 RM transmissions collected over a 15-month follow-up (FU) and who were enrolled in the LION registry were included in the analysis. Atrial arrhythmia burden subgroups were defined as AB = 0 (no AB on any day during FU) versus AB > 0 (AB > 0 on at least one day during FU). Only patients (n=274) with a minimum of 45 RM transmissions and additional historical information of atrial fibrillation (AF) occurrence prior to enrolment were included in the analyses. Results: Of the 274 patients fulfilling the predefined criteria, 36.1% (99 patients) with AB > 0 and 63.9% (175 patients) with AB = 0 during FU were identified. Based on the following baseline characteristics, subjects with AB > 0 differed from those without AB (p < 0.05): They were more frequently in a NYHA functional class ≥III (AB = 0: 15% vs. AB > 0: 31%, p = 0.003), had a lower mean LVEF (AB = 0: 36.6±13.6% vs. AB > 0: 33.1±12.2%, p = 0.047) and had more frequently a history of AF (AB = 0: 13% vs. AB > 0: 40%, p < 0.001). Furthermore, subjects with AB during FU were older (AB = 0: 65.1±10.8 years vs. AB > 0: 67.5±10.1 years; p = 0.071). There was no substantial difference between groups with respect to gender, body mass index, secondary prevention indication, non-cardiac medical history, and medication. Of the 211 patients without a history of AF, 28.0% (59 patients) developed De novo high rate atrial arrhythmias during FU. For 36.5% (23 patients) with a history of AF, an AB = 0 was detected during the observational period. Conclusions: Due to their greater morbidity, the occurrence of atrial arrhythmia reflects an important issue for ICD patients. In this case, an optimal anticoagulation therapy might be potentially helpful in preventing the occurrence of embolic stroke. In our cohort, patients with AF detected by RM suffered from progressive heart failure, low ejection fraction, and had a previous history of AF. In addition, RM-based recording of AF might help to initiate a more individual anticoagulation strategy to prevent bleeding in course of continuous anticoagulation therapy.