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Clinical factors associated with baseline history of atrial fibrillation and subsequent clinical outcomes following initial implantable cardioverter‐defibrillator placement
Author(s) -
Giancaterino Shaun,
Nishimura Marin,
BirgersdotterGreen Ulrika,
Hoffmayer Kurt S.,
Han Frederick T.,
Raissi Farshad,
Ho Gordon,
Krummen David,
Feld Gregory K.,
Hsu Jonathan C.
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13919
Subject(s) - medicine , atrial fibrillation , implantable cardioverter defibrillator , proportional hazards model , hazard ratio , cardiology , heart failure , confounding , logistic regression , confidence interval
Background Atrial fibrillation (AF) is frequently present in patients with heart failure (HF) and an implantable cardioverter‐defibrillator (ICD). This study aims to identify clinical factors associated with a baseline history of AF in ICD recipients, and compares subsequent clinical outcomes in those with and without a baseline history of AF. Methods We studied 566 consecutive first‐time ICD recipients at an academic center between 2011 and 2018. Logistic regression multivariable analyses were used to identify clinical factors associated with a baseline history of AF at the time of ICD implant. Cox‐proportional hazard regression models were constructed for multivariate analysis to examine associations between a baseline history of AF with subsequent clinical outcomes, including ICD therapies, HF readmission, and all‐cause mortality. Results Of all patients, 201 (36%) had a baseline history of AF at the time of ICD implant. In multivariate analyses, clinical factors associated with a baseline history of AF included hypertension, valvular heart disease, body weight, PR interval, and serum creatinine level. After multivariate adjustment for potential confounders, a baseline history of AF was associated with an increased risk of anti‐tachycardia pacing (HR = 1.84, 95% CI = 1.19‐2.85, P = .006), appropriate ICD shocks (HR = 1.80, 95% CI = 1.05‐3.09, P = .032), and inappropriate ICD shocks (HR = 3.72, 95% CI = 1.7‐7.77, P = .0001), but not other adverse outcomes. Conclusion Among first‐time ICD recipients, specific clinical characteristics were associated with a baseline history of AF at the time of ICD implant. After adjustment for potential confounders, a baseline history of AF was associated with a higher risk of all ICD therapies in follow‐up.