The Epidemic of Inadequate Biventricular Pacing in Patients With Persistent or Permanent Atrial Fibrillation and Its Association With Mortality

​CIRCEP: May 17, 2014

Background—We classified patients’ atrial fibrillation (AF), assessed its impact on biventricular pacing (BIVP%), and determined whether AF classification or BIVP% independently correlate with mortality in cardiac resynchronization therapy defibrillator patients.

Methods and Results—Cardiac resynchronization therapy defibrillator patients were classified as permanent (daily mean AF burden ≥23 hours), persistent (≥7 consecutive days of AF ≥23 hours/d), paroxysmal (≥1 day with AF ≥6 hours), or no/little AF (all others) using device-detected AF during the 6 months postimplant. We evaluated subsequent all-cause mortality using a multivariable Cox proportional hazard regression. Among 54 019 patients (age, 70±11 years; 73% male; follow-up, 2.3±1.2 years), 8% of patients each had permanent (N=4449), persistent (N=4237), and paroxysmal AF (N=4219). A high proportion of patients with permanent (69%) and persistent (62%) AF did not achieve high BIVP (>98%). Read More

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