Author + information
- Received January 1, 2018
- Revision received February 28, 2018
- Accepted March 6, 2018
- Published online June 4, 2018.
- Jorge A. Wong, MD, MPHa,∗ (, )
- David Conen, MD, MPHa,
- Isabelle C. Van Gelder, MDb,
- William F. McIntyre, MDa,
- Harry J. Crijns, MDc,d,
- Jia Wang, MSca,
- Michael R. Gold, MDe,
- Stefan H. Hohnloser, MDf,
- C.P. Lau, MDg,
- Alessandro Capucci, MDh,
- Gianluca Botto, MDi,
- Gerian Grönefeld, MDj,
- Carsten W. Israel, MDe,
- Stuart J. Connolly, MDa and
- Jeff S. Healey, MD, MSca
- aDivision of Cardiology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- bDepartment of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- cDepartment of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- dCardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- eDepartment of Medicine, Medical University of South Carolina, Charleston, South Carolina
- fDepartment of Electrophysiology, J.W. Goethe University, Frankfurt, Germany
- gDepartment of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
- hDepartment of Cardiovascular Sciences, Clinica di Cardiologia, Università Politecnica delle Marche, Ancona, Italy
- iDepartment of Medicine, Hospital Sant’Anna, Como, Italy
- jDepartment of Medicine, Asklepios Klinik Barmbek, Hamburg, Germany
- ↵∗Address for correspondence:
Dr. Jorge A. Wong, Population Health Research Institute, 237 Barton Street East, DBCVSRI Room C3-11D, Hamilton, Ontario L8L 2X2, Canada.
Background Long-term continuous monitoring detects short-lasting, subclinical atrial fibrillation (SCAF) in approximately one-third of older individuals with cardiovascular conditions. The relationship between SCAF, its progression, and the development of heart failure (HF) is unclear.
Objectives This study examined the relationship between progression from shorter to longer SCAF episodes and HF hospitalization.
Methods Subjects in ASSERT (Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial) were ≥65 years old, had history of hypertension, no prior clinical AF, and an implanted pacemaker or defibrillator. We examined patients whose longest SCAF episode during the first year after enrollment was >6 min but ≤24 h (n = 415). Using time-dependent Cox models, we evaluated the relationship between subsequent development of SCAF >24 h or clinical AF and HF hospitalization.
Results Over a mean follow-up of 2 years, 65 patients (15.7%) progressed to having SCAF episodes >24 h or clinical AF (incidence 8.8% per year). Older age, greater body mass index, and longer SCAF duration within the first year were independent predictors of SCAF progression. The rate of HF hospitalization among patients with SCAF progression was 8.9% per year compared with 2.5% per year for those without progression. After multivariable adjustment, SCAF progression was independently associated with HF hospitalization (hazard ratio [HR]: 4.58; 95% confidence interval [CI]: 1.64 to 12.80; p = 0.004). Similar results were observed when we excluded patients with prior history of HF (HR: 7.06; 95% CI: 1.82 to 27.30; p = 0.005) or when SCAF progression was defined as development of SCAF >24 h alone (HR: 3.68; 95% CI: 1.27 to 10.70; p = 0.016).
Conclusions In patients with a pacemaker or defibrillator, SCAF progression was strongly associated with HF hospitalization.
- atrial fibrillation
- atrial fibrillation progression
- health outcome
- heart failure
- subclinical atrial fibrillation
The ASSERT trial was funded by St. Jude Medical. Dr. Wong was supported by a Canadian Institutes of Health Research Fellowship award. Drs. Van Gelder and Crijns have received support from the Netherlands Cardiovascular Research Initiative and the Dutch Heart Foundation (CVON 2014-9). Dr. Gold is on the steering committee for Boston Scientific Corporation, Medtronic, and St. Jude; and has received consulting and lecture fees from Medtronic and Boston Scientific Corporation. Dr. Hohnloser is a consultant for Abbott, Medtronic, Boehringer Ingelheim, Bayer, Bristol-Myers Squibb, and Pfizer. Dr. Israel has received honoraria for presentations, reimbursement of travel costs, and congress fees from Abbott and St. Jude Medical. Dr. Connolly has received grant support and consulting fees from Abbott. Dr. Healey is supported by a personnel award from the Heart and Stroke Foundation, Ontario, Canada (MC7450) and the Population Health Research Institute Chair in Cardiology Research at McMaster University; has received research grants from St. Jude Medical, Boehringer Ingelheim, Medtronic, Bristol-Myers Squibb/Pfizer, and Boston Scientific; and speaking fees from St. Jude Medical, Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 1, 2018.
- Revision received February 28, 2018.
- Accepted March 6, 2018.
- 2018 American College of Cardiology Foundation
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