Atrial Fibrillation Burden and Atrial Shunt Therapy in Heart Failure With Preserved Ejection Fraction

被引：7

作者：

Patel, Ravi B. ^{[1
,2
]}

Reddy, Vivek Y. ^{[3
]}

Komtebedde, Jan ^{[4
]}

Wegerich, Stephan W. ^{[5
]}

Sekaric, Jadranka ^{[5
]}

Swarup, Vijay ^{[6
]}

Walton, Antony ^{[7
]}

Laurent, Gabriel ^{[8
]}

Chetcuti, Stanley ^{[9
]}

Rademann, Matthias ^{[10
]}

Bergmann, Martin ^{[11
]}

McKenzie, Scott ^{[12
]}

Bugger, Heiko ^{[13
]}

Bruno, Raphael Romano ^{[14
]}

Herrmann, Howard C. ^{[15
]}

Nair, Ajith ^{[16
]}

Gupta, Deepak K. ^{[17
]}

Lim, Scott ^{[18
]}

Kapadia, Samir ^{[19
]}

Gordon, Robert ^{[20
]}

Vanderheyden, Marc ^{[21
]}

Noel, Thomas ^{[22
]}

Bailey, Steven ^{[23
]}

Gertz, Zachary M. ^{[24
]}

Trochu, Jean-Noel ^{[25
]}

Cutlip, Donald E. ^{[26
]}

Leon, Martin B. ^{[27
]}

Solomon, Scott D. ^{[28
]}

van Veldhuisen, Dirk J. ^{[29
]}

Auricchio, Angelo ^{[30
]}

Shah, Sanjiv J. ^{[1
]}

机构：

[1] Northwestern Univ, Feinberg Sch Med, Dept Med, Div Cardiol, 676 North St Clair St,Suite 730, Chicago, IL USA

[2] Northwestern Univ, Feinberg Sch Med, Dept Prevent Med, Evanston, IL 60208 USA

[3] Icahn Sch Med Mt Sinai, Helmsley Electrophysiol Ctr, New York, NY USA

[4] Corvia Med Inc, Tewksbury, MA USA

[5] physIQ Inc, Chicago, IL USA

[6] Arizona Hearth Rhythm, Phoenix, AZ USA

[7] Alfred Hlth, Heart Ctr, Melbourne, Australia

[8] Dijon Univ Hosp, Dept Cardiol, Dijon, France

[9] Univ Michigan, Div Cardiol, Sch Med, Ann Arbor, MI USA

[10] Univ Giessen, Dept Neurol, Bad Nauheim, Germany

[11] Cardiologicum, Dept Intervent Cardiol, Hamburg, Germany

[12] Univ Queensland, Prince Charles Hosp, Sch Med, Brisbane, Australia

[13] Med Univ Graz, Div Cardiol, Graz, Austria

[14] Heinrich Heine Univ Dusseldorf, Univ Hosp Dusseldorf, Fac Med, Div Cardiol, Dusseldorf, Germany

[15] Univ Penn, Perelman Sch Med, Div Cardiol, Philadelphia, PA USA

[16] Baylor Coll Med, Div Cardiol, Houston, TX USA

[17] Vanderbilt Univ, Med Ctr, Div Cardiovasc Med, Nashville, TN USA

[18] Univ Virginia, Div Cardiol, Sch Med, Charlottesville, VA USA

[19] Cleveland Clin, Div Cardiol, Cleveland, OH USA

[20] NorthShore Univ Hlth Syst, Div Cardiol, Evanston, IL USA

[21] Onze Lieve Vrouw Hosp, Cardiovasc Ctr Aalst, Aalst, Belgium

[22] Southern Med Grp PA, Florida, PA USA

[23] Louisiana State Univ, Div Cardiol, Sch Med, Baton Rouge, LA USA

[24] Virginia Commonwealth Univ, Sch Med, Div Cardiol, Richmond, VA USA

[25] Nantes Univ, Inst Thorax, CHU Nantes, CNRS,INSERM, Nantes, France

[26] Beth Israel Deaconess Med Ctr, Div Cardiol, Boston, MA USA

[27] Columbia Univ, New York Presbyterian Hosp, Irving Med Ctr, New York, NY USA

[28] Brigham & Womens Hosp, Div Cardiol, Boston, MA USA

[29] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands

[30] Ticino Cardioctr Inst, Div Cardiol, Lugano, Switzerland

来源：

JACC-HEART FAILURE | 2023年 / 11卷 / 10期

关键词：

atrial fibrillation; burden; clinical trial; heart failure; shunt; PATENT FORAMEN OVALE; CLOSURE; ASSOCIATIONS;

D O I：

10.1016/j.jchf.2023.05.024

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Atrial fibrillation (AF) is a common comorbidity in patients with heart failure with preserved ejection fraction (HFpEF) and in heart failure with mildly reduced ejection fraction (HFmrEF). OBJECTIVES This study sought to describe AF burden and its clinical impact among individuals with HFpEF and HFmrEF who participated in a randomized clinical trial of atrial shunt therapy (REDUCE LAP-HF II [A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure]) and to evaluate the effect of atrial shunt therapy on AF burden. METHODS Study investigators characterized AF burden among patients in the REDUCE LAP-HF II trial by using ambulatory cardiac patch monitoring at baseline (median patch wear time, 6 days) and over a 12-month follow-up (median patch wear time, 125 days). The investigators determined the association of baseline AF burden with long-term clinical events and examined the effect of atrial shunt therapy on AF burden over time. RESULTS Among 367 patients with cardiac monitoring data at baseline and follow-up, 194 (53%) had a history of AF or atrial flutter (AFL), and median baseline AF burden was 0.012% (IQR: 0%-1.3%). After multivariable adjustment, baseline AF burden >= 0.012% was significantly associated with heart failure (HF) events (HR: 2.00; 95% CI: 1.17-3.44; P 1/4 0.01) both with and without a history of AF or AFL (P for interaction 1/4 0.68). Adjustment for left atrial reservoir strain attenuated the baseline AF burden-HF event association (HR: 1.71; 95% CI: 0.93-3.14; P 1/4 0.08). Of the 367 patients, 141 (38%) had patch-detected AF during follow-up without a history of AF or AFL. Atrial shunt therapy did not change AF incidence or burden during follow-up. CONCLUSIONS In HFpEF and HFmrEF, nearly 40% of patients have subclinical AF by 1 year. Baseline AF burden, even at low levels, is associated with HF events. Atrial shunt therapy does not affect AF incidence or burden. (A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure [REDUCE LAP-HF II]; NCT03088033) (c) 2023 by the American College of Cardiology Foundation.

引用

页码：1351 / 1362

页数：12

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