P1045Impact of stroke events in Japanese patients with atrial fibrillation detected by implantable cardioverter defibrillator

Abstract Background Sacubitril/valsartan, the first combined angiotensin receptor-neprilysin inhibitor, has demonstrated a significant benefit compared to angiotensin inhibitor in decreasing ventricular arrhythmias and appropriate implantable cardioverter defibrillator (ICD) shocks in patients with heart failure with reduced ejection fraction (HFrEF). At present, there is no study which evaluates the effect of sacubitril/valsartan on the supraventricular arrhythmic burden in HFrEF patients with an ICD or cardiac resynchronisation therapy-defibrillator (CRT-D) and remote monitoring. Purpose To evaluate the effect of sacubitril/valsartan on the supraventricular arrhythmic burden in HFrEF patients with an ICD or CRTD and remote monitoring. Methods The SAVETHERHYTHM ((SAacubitril Valsartan rEal-world registry evaluating THE arRHYTHMia burden in HFrEF patients with implantable cardioverter defibrillator) is a multicentre, observational, prospective registry enrolling all patients with HFrEF, ICD or CRT-D actively followed through remote monitoring and starting treatment with sacubitril/valsartan. All patients are followed-up for at least one year after sacubitril/valsartan start. The primary endpoint is the mean number of sustained atrial tachycardia or atrial fibrillation (AT/AF) episodes per month. Secondary endpoints include the total burden of AT/AF (defined as the percentage of time in AT/AF per day), the mean number of premature ventricular contractions (PVC) per hour and the percentage of biventricular pacing per day (in patients with CRT-D). All primary and secondary endpoints are collected through remote monitoring. Results At the time of the first ad interim analysis, 60 patients (85.2% male, age 69±10 years) were consecutively enrolled. After treatment with sacubitril/valsartan, patients with at least one episode of AT/AF per month decreased from 32.8% to 21.3% (p=0.015). A significant decrease in number of AT/AF episodes (from 4.3 to 1.2 per year), in AT/AF burden (from 12% to 9%) and in number of PVC (from 83 to 74 per hour) were seen in patients with a previous diagnosis of paroxysmal or persistent AF (n=15; all p<0.05). Patients with permanent AF (n=7) experienced no benefits from sacubitril/valsartan therapy in terms of arrhythmic burden reduction. Patients with no previous history of AF (n=38) showed a decrease in number of AT/AF episodes (from 2.0 to 0.8 per year) and in number of PVC (from 77 to 49 per hour, all p<0.05). No new diagnosis of clinical AF was made after starting treatment with sacubitrl/valsartan, and patients with subclinical AT/AF episodes decreased from 8% to 3%. Conclusions Preliminary data suggest that therapy with sacubitril/valsartan could decrease arrhythmic burden in patients with non-permanent AF and reduce subclinical AT/AF episodes in patients with no history of AF. No positive effect has been noted in patients with permanent AF. Funding Acknowledgement Type of funding source: None

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Incidence of Ventricular Arrhythmias and 1‐Year Predictors of Mortality in Patients Treated With Implantable Cardioverter‐Defibrillator Undergoing Generator Replacement

Journal of the American Heart Association ◽

10.1161/jaha.120.018090 ◽

2021 ◽

Vol 10 (4) ◽

Author(s):

Andrea Demarchi ◽

Stefano Cornara ◽

Antonio Sanzo ◽

Simone Savastano ◽

Barbara Petracci ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Implantable Cardioverter Defibrillator ◽

Ventricular Arrhythmias ◽

Multivariable Analysis ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Cardioverter Defibrillator ◽

Generator Replacement

Background When implantable cardioverter defibrillator (ICD) battery is depleted most patients undergo generator replacement (GR) even in the absence of persistent ICD indication. The aim of this study was to assess the incidence of ventricular arrhythmias and the overall prognosis of patients with and without persistent ICD indication undergoing GR. Predictors of 1‐year mortality were also analyzed. Methods and Results Patients with structural heart disease implanted with primary prevention ICD undergoing GR were included. Patients were stratified based on the presence/absence of persistent ICD indication (left ventricular ejection fraction ≤35% at the time of GR and/or history of appropriate ICD therapies during the first generator's life). The study included 371 patients (82% male, 40% with ischemic heart disease). One third of patients (n=121) no longer met ICD indication at the time of GR. During a median follow‐up of 34 months after GR patients without persistent ICD indication showed a significantly lower incidence of appropriate ICD shocks (1.9% versus 16.2%, P <0.001) and ICD therapies. 1‐year mortality was also significantly lower in patients without persistent ICD indication (1% versus 8.3%, P =0.009). At multivariable analysis permanent atrial fibrillation, chronic advanced renal impairment, age >80, and persistent ICD indication were found to be significant predictors of 1‐year mortality. Conclusions Patients without persistent ICD indication at the time of GR show a low incidence of appropriate ICD therapies after GR. Persistent ICD indication, atrial fibrillation, advanced chronic renal disease, and age >80 are significant predictors of 1‐year mortality. Our findings enlighten the need of performing a comprehensive clinical reevaluation of ICD patients at the time of GR.

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DIAGNOSIS OF ATRIAL FIBRILLATION IN HEART FAILURE PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATOR OR CARDIAC RESYNCHRONISATION THERAPY.

Archives of Medical Science ◽

10.5114/aoms/114977 ◽

2021 ◽

Author(s):

Barbara Dominik ◽

Mitkowski Przemyslaw ◽

Wojciech Zorawski ◽

Ilona Kowalik ◽

Adam Ciesielski

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Implantable Cardioverter Defibrillator ◽

Cardiac Resynchronisation Therapy ◽

Predisposing Factors ◽

Study Group ◽

Cardioverter Defibrillator ◽

Cardiac Resynchronisation ◽

Resynchronisation Therapy

IntroductionImplantable cardioverter defibrillators register various types of arrhythmias. Thus they can be exploited to better identify patients with atrial fibrillation episodes and increase the proportion of patients who may benefit from implementation of pharmacological prophylaxis of thromboembolic events, most of which it turns out are asymptomatic.Material and methodsAssessment of the frequency, symptoms and predisposing factors for the occurrence of atrial fibrillation episodes in patients with implanted ICD (implantable cardioverter defibrillator) and CRT-D (cardiac resynchronisation therapy with defibrillator) based on the analysis of intracardiac electrocardiograms (IEGM) records. The study included 174 consecutive outpatient cases with heart failure, sinus rhythm and Implanted Cardioverter Defibrillator and Cardiac Resynchronisation Therapy with Defibrillator. Control visits with analysis of IEGM records occurred every three months. During mean follow-up of 20 months, 901 visits were carried out. 147 patients had at least one year of follow-up.ResultsAtrial fibrillation episodes in the study group occurred in 54 (31.0%) of patients and 71.4% were asymptomatic. Predisposing factors were: history of paroxysmal atrial fibrillation (37.0% vs 13.3%, p ˂ 0.001), atrioventricular conduction abnormalities (42.6% vs. 20.0%, p = 0.002), intraventricular conduction abnormalities (59.3% vs 40.8%, p = 0.02) and more severe mitral regurgitation (7.4% vs 0.8%, p = 0.04). Chronic renal disease was a risk factor for death in the study group. No stroke occurred during the study.ConclusionsEpisodes of paroxysmal AF in patients with systolic heart failure and implanted cardioverter-defibrillator systems are quite common. The majority of the episodes recorded in the study were asymptomatic.

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The Adequate Usage of Implantable Cardioverter Defibrillator in Japanese Patients with Congestive Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2005.08.016 ◽

2005 ◽

Vol 11 (9) ◽

pp. S236

Author(s):

Takashi Kurita ◽

Kazuhiro Satomi ◽

Satoko Kitamura ◽

Shiro Kamakura

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Implantable Cardioverter Defibrillator ◽

Japanese Patients ◽

Cardioverter Defibrillator

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Tachycardias

Oxford Handbook of Cardiac Nursing ◽

10.1093/med/9780199651344.003.0012 ◽

2014 ◽

pp. 243-260 ◽

Cited By ~ 1

Keyword(s):

Atrial Fibrillation ◽

Sudden Cardiac Death ◽

General Population ◽

Implantable Cardioverter Defibrillator ◽

Cardiac Death ◽

Cardioverter Defibrillator ◽

Priority Areas ◽

Diagnosis And Management ◽

Broad Complex

This chapter looks at the diagnosis and management of tachycardias, including both narrow complex tachycardias and broad complex tachycardias. Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting 1–2% of the general population (5–15% of those over 80 years). There have been a number of developments in arrhythmia care over the last few years in particular in relation to AF and there are now more specialist arrhythmia nurses and nurse-led arrhythmia services than before. AF, arrhythmias, and sudden cardiac death are priority areas of NHS improvement. Recent guidelines for the management of tachycardias are discussed including pharmacological measure, cardioversion, and implantable cardioverter-defibrillator (ICD) insertion.

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