Atrial fibrillation is a marker of increased mortality risk in nonischemic heart failure—Results from the DANISH trial - 23/01/21
, Jens Jakob Thune, MD, PhD b, c, Steen Pehrson, MD, DMSc b, d, Lars Køber, MD, DMSc b, d, Jens C. Nielsen, MD, DMSc e, Lars Videbæk, MD, PhD f, Jens Haarbo, MD, DMSc g, Eva Korup, MD, PhD h, Niels Eske Bruun, MD, DMSc b, i, Axel Brandes, MD f, Hans Eiskjær, MD, DMSc e, Anna M. Thøgersen, MD, PhD h, Berit T. Philbert, MD d, Jesper Hastrup Svendsen, MD, DMSc b, d, Ulrik Dixen, MD, PhD a, bRiassunto |
Background |
Atrial fibrillation (AF) in heart failure (HF) patients has been associated with a worse outcome. Similarly, excessive supraventricular ectopic activity (ESVEA) has been linked to development of AF, stroke, and death. This study aimed to investigate AF and ESVEA's association with outcomes and effect of prophylactic implantable cardioverter defibrillator (ICD) implantation in nonischemic HF patients.
Methods |
A total of 850 patients with nonischemic HF, left ventricle ejection fraction ≤35%, and elevated N-terminal pro-brain natriuretic peptides underwent 24 hours Holter recording. The presence of AF (≥30 seconds) and ESVEA (≥30 supraventricular ectopic complexes (SVEC) per hour or run of SVEC ≥20 beats) were registered. Outcomes were all-cause mortality, cardiovascular death (CVD), and sudden cardiac death (SCD).
Results |
AF was identified in 188 patients (22%) and ESVEA in 84 patients (10%). After 4 years and 11 months of follow-up, a total of 193 patients (23%) had died. AF was associated with all-cause mortality (hazard ratio [HR] 1.44; confidence interval [CI] 1.04-1.99; P = .03) and CVD (HR 1.59; CI 1.07-2.36; P = .02). ESVEA was associated with all-cause mortality (HR 1.73; CI 1.16-2.57; P = .0073) and CVD (HR 1.76; CI 1.06-2.92; P = .03). Neither AF nor ESVEA was associated with SCD. ICD implantation was not associated with an improved prognosis for neither AF (P value for interaction = .17), nor ESVEA (P value for interaction = .68).
Conclusions |
Both AF and ESVEA were associated with worsened prognosis in nonischemic HF. However, ICD implantation was not associated with an improved prognosis for either group.
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| Funding: This study was supported by The Danish Heart Foundation (grant number 17-R116-A7647-22064) and by The Hospital's Independent Research Funds, Copenhagen University Hospital Amager and Hvidovre, Denmark. Neither funds have had any influence on the design, conduct, analyses, or publications of the study. |
Vol 232
P. 61-70 - Febbraio 2021 Ritorno al numero
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