Background

Cardiac implanted electronic devices (CIEDs) can detect short durations of previously unrecognised atrial fibrillation (AF). The prognostic significance of device-detected subclinical AF, in the context of contemporary heart failure (HF) therapy, is unclear.

Methods

Amongst patients enrolled in the Remote Monitoring in HF with implanted devices (REM-HF) trial, three categories were defined based on total AF duration in the first year of follow-up: no AF, subclinical AF (≥6 min to ≤24 h), and AF >24 h. All-cause mortality, stroke, and cardiovascular hospitalisation were assessed.

Results

1561 patients (94.6%) had rhythm data: 71 (4.6%) had subclinical AF (median of 4 episodes, total duration 3.1 h) and 279 (17.9%) had AF >24 h. During 2.8 ± 0.8 years' follow-up, 39 (2.5%) patients had a stroke. Stroke rate was highest amongst patients with subclinical AF (2.0 per 100-person years) versus no AF or AF >24 h (0.8 and 1.0 per 100-person years, respectively). In the overall cohort, AF >24 h was not an independent predictor of stroke. However, amongst patients with no history of AF (n = 932), new-onset subclinical AF conferred a three-fold higher stroke risk (adjusted HR 3.35, 95%CI 1.15–9.77, p = 0.027). AF >24 h was associated with more frequent emergency cardiovascular hospitalisation (adjusted HR 1.46, 95%CI 1.19–1.79, p < 0.0005). Neither AF classification was associated with mortality.

Conclusions

In patients with HF and a CIED, subclinical AF was infrequent but, as a new finding, was associated with an increased risk of stroke. Anticoagulation remains an important consideration in this population, particularly when the clinical profile indicates a high stroke risk.

中文翻译：

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在心力衰竭和射血分数降低的患者中，设备检测到的亚临床心房颤动的患病率和预后意义。

背景

心脏植入式电子设备（CIED）可以检测到以前无法识别的心房颤动（AF）的短时间。目前尚不清楚在现代心力衰竭（HF）治疗的背景下，设备检测到的亚临床AF的预后意义。

方法

在参加有植入设备的HF远程监测（REM-HF）试验的患者中，根据随访的第一年的总房颤持续时间将其分为三类：无房颤，亚临床房颤（≥6分钟至≤24小时） ），并且AF> 24小时。评估了全因死亡率，中风和心血管住院。

结果

1561例患者（94.6％）的心律数据：71例（4.6％）的亚临床性AF（中位数4次发作，总持续时间3.1 h）和279例（17.9％）的AF> 24 h。在2.8±0.8年的随访期间，有39名（2.5％）患者患有中风。亚临床房颤患者中风发生率最高（每100人年2.0例），而无房颤或房颤> 24小时的房颤患者（每100人年分别0.8和1.0）。在整个队列中，AF> 24 h不是卒中的独立预测因子。然而，在无房颤史的患者中（n = 932），新发亚临床房颤的中风风险增加了三倍（校正后的HR 3.35，95％CI 1.15-9.77，p = 0.027）。AF> 24 h与更频繁的紧急心血管疾病住院治疗相关（校正后的HR 1.46，95％CI 1.19-1.79，p <0.0005）。AF分类均与死亡率无关。

结论

在HF和CIED患者中，亚临床AF很少见，但作为一项新发现，与中风风险增加相关。抗凝治疗仍然是该人群的重要考虑因素，特别是当临床表现出高中风风险时。