Clinical InvestigationElectrophysiologyBurden of atrial fibrillation and poor rate control detected by continuous monitoring and the risk for heart failure hospitalization

IntroductionAtrial fibrillation (AF) on electrocardiogram has been identified as a risk factor for hospitalizations in patients with heart failure (HF). We investigated whether continuous AF monitoring can identify when patients with HF are at risk for hospitalization.MethodsIn this retrospective analysis of data from 4 studies enrolling patients with HF with cardiac resynchronization therapy defibrillator devices with ≥90 days of follow-up (n = 1561), patients were identified as having AF if they had ≥1 day of >5 minutes of AF and >1 hour of total AF during entire follow-up. In patients with AF, device recorded AF burden (AFb) and ventricular rate during AF (VRAF) over the last 30 days was classified on a monthly basis into 3 evaluation groups: (1) ≥1 day of high burden of paroxysmal AF (≥6 hours) or persistent AF (all 30 days with AFb >23 hours) with poor rate control (VRAF >90 beats/min), (2) ≥1 day of high burden of paroxysmal AF with good rate control (VRAF ≤ 90 beats/min), and (3) no days with high burden of AF (AFb <6 hours) or persistent AF with good rate control. Each group was compared with monthly evaluations in patients without AF using an Anderson-Gill model for occurrence of HF hospitalizations in the next 30 days.ResultsPatients with AF (n = 519, 33%) have a greater risk (hazard ratio [HR] 2.0, P < .001) for impending HF hospitalizations during entire follow-up compared with patients with no AF. One day of high burden of paroxysmal AF with good rate control in the last 30 days increases risk for HF hospitalization in the next 30 days (HR 3.4, P < .001). The risk increases further (HR 5.9, P < .001) with 1 day of poor rate control during persistent AF or high burden paroxysmal AF in last 30 days.ConclusionEvaluation of AFb and rate control information on a monthly basis can identify patients at risk for HF hospitalization in the next 30 days.