PMID- 21558331
OWN - NLM
STAT- MEDLINE
DCOM- 20120117
LR  - 20201216
IS  - 1879-0844 (Electronic)
IS  - 1388-9842 (Linking)
VI  - 13
IP  - 8
DP  - 2011 Aug
TI  - Incidence and clinical relevance of uncontrolled ventricular rate during atrial 
      fibrillation in heart failure patients treated with cardiac resynchronization 
      therapy.
PG  - 868-76
LID - 10.1093/eurjhf/hfr046 [doi]
AB  - AIMS: Uncontrolled ventricular rate (VR) during atrial fibrillation (AF) may 
      cause clinical deterioration in heart failure (HF) patients who need continuous 
      biventricular pacing to achieve cardiac resynchronization therapy (CRT). We aimed 
      at evaluating the association between AF, uncontrolled VR, and sub-optimal CRT, 
      defined as low biventricular pacing percentage (BIVP%). METHODS AND RESULTS: All 
      1404 patients had HF, New York Heart Association (NYHA) >/=II, left ventricular 
      ejection fraction (LVEF) </=35%, and QRS >/=120 ms, and received an implantable CRT 
      defibrillator (CRT-D). Occurrence of AF, VR during AF and lifetime BIVP% were 
      estimated from device data. Ventricular rate during AF was defined as 
      uncontrolled in patients with mean VR>80 bpm and maximum VR>110 bpm. Over a 
      median follow-up of 18 months, AF was detected in 443 of 1404 patients (32%). In 
      this sub-group of AF patients, VR during AF was uncontrolled in 150 of 443 
      patients (34%). Multivariate Cox regression analysis showed that age [hazard 
      ratio (HR) = 1.03, 95% confidence interval (CI) = 1.00-1.06, P= 0.028], and 
      uncontrolled VR [HR = 1.69 (CI = 1.01-2.83), P= 0.046] were the only independent 
      predictors of clinical outcome, assessed by HF hospitalizations and death. The 
      median lifetime BIVP% was 95% (25-75 percentile range 91-99%). Biventricular 
      pacing percentage was significantly and inversely correlated to VR, decreasing by 
      7% for each 10 bpm increase in VR. Sub-optimal CRT, defined as BIVP% <95%, was 
      predicted by the occurrence of persistent or permanent AF [odds ratio (OR) = 
      3.77, CI = 2.44-5.82, P< 0.001], and uncontrolled VR [OR = 2.25, CI = 1.35-3.73, 
      P= 0.002]. CONCLUSION: Uncontrolled VR occurs in one-third of CRT-D patients, who 
      experience AF, and is associated with HF hospitalizations and death and with 
      sub-optimal CRT (lifetime BIVP%<95%).
FAU - Boriani, Giuseppe
AU  - Boriani G
AD  - Institute of Cardiology, University of Bologna and Azienda Ospedaliera S. 
      Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy. boriani@gmail.com
FAU - Gasparini, Maurizio
AU  - Gasparini M
FAU - Landolina, Maurizio
AU  - Landolina M
FAU - Lunati, Maurizio
AU  - Lunati M
FAU - Proclemer, Alessandro
AU  - Proclemer A
FAU - Lonardi, Gabriele
AU  - Lonardi G
FAU - Iacopino, Saverio
AU  - Iacopino S
FAU - Rahue, Werner
AU  - Rahue W
FAU - Biffi, Mauro
AU  - Biffi M
FAU - DiStefano, Paola
AU  - DiStefano P
FAU - Grammatico, Andrea
AU  - Grammatico A
FAU - Santini, Massimo
AU  - Santini M
CN  - ClinicalService cardiac centres
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20110510
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
SB  - IM
MH  - Aged
MH  - Arrhythmias, Cardiac/epidemiology
MH  - Atrial Fibrillation/*epidemiology
MH  - Cardiac Pacing, Artificial
MH  - *Cardiac Resynchronization Therapy
MH  - Comorbidity
MH  - Female
MH  - Heart Failure/*therapy
MH  - Heart Ventricles/*physiopathology
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
EDAT- 2011/05/12 06:00
MHDA- 2012/01/18 06:00
CRDT- 2011/05/12 06:00
PHST- 2011/05/12 06:00 [entrez]
PHST- 2011/05/12 06:00 [pubmed]
PHST- 2012/01/18 06:00 [medline]
AID - hfr046 [pii]
AID - 10.1093/eurjhf/hfr046 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2011 Aug;13(8):868-76. doi: 10.1093/eurjhf/hfr046. Epub 2011 
      May 10.