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Journal of Interventional Cardiac Electrophysiology

Published in:

01-06-2019 | Cardiomyopathy

Predictors of rate-adaptive pacing in patients implanted with implantable cardioverter–defibrillator and subsequent differential clinical outcomes

Authors: Nils Källner, Marin Nishimura, Ulrika Birgersdotter-Green, Kurt S. Hoffmayer, Frederick T. Han, David E. Krummen, Farshad Raissi, Gregory K. Feld, Jonathan C. Hsu

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 1/2019

Abstract

Purpose

Patients with severe cardiomyopathy often have chronotropic incompetence, which is predominantly managed by activating rate-adaptive pacing in patients implanted with an implantable cardioverter–defibrillator (ICD) capable of atrial pacing. The purpose of this study was to determine predictors of rate-adaptive pacing activation, the cumulative incidence of activation, and the association of rate-adaptive pacing activation with subsequent clinical outcomes in an ICD population.

Methods

The authors evaluated 228 patients implanted with an ICD between 2011 and 2015. Multivariable logistic regression was used to evaluate predictors of rate-adaptive pacing activation. Cox proportional–hazards regression was used to examine associations of rate-adaptive pacing activation and clinical outcomes.

Results

Rate-adaptive pacing was turned on in 38.5% (n = 88) of patients during follow-up. Several statistically significant predictors of rate-adaptive pacing activation were found, particularly previous atrial fibrillation (odds ratio [OR] = 8.27, 95% confidence interval [CI] = 2.96–23.06, p < 0.001), previous myocardial infarction (OR = 4.17, 95% CI = 1.38–12.58, p = 0.01), and non-ischemic cardiomyopathy (OR = 3.83, 95% CI = 1.22–12.00, p = 0.02). In multivariable adjusted analyses, rate-adaptive pacing activation within 30 days of implantation was not associated with the risk of device therapy for tachyarrhythmias (hazard ratio [HR] = 1.52, 95% CI = 0.71–3.28, p = 0.29), atrial fibrillation (HR = 1.42, 95% CI = 0.71–2.87, p = 0.32), HF re-admission (HR = 1.39, 95% CI = 0.80–2.43, p = 0.25), nor all-cause mortality (HR = 2.34, 95% CI = 0.80–6.84, p = 0.12).

Conclusions

During follow-up, more than one in three HF patients implanted with an ICD developed the need for rate-adaptive pacing. Atrial fibrillation, prior myocardial infarction, and non-ischemic cardiomyopathy were statistically significant baseline clinical predictors of rate-adaptive pacing activation. Rate-adaptive pacing activation was not associated with subsequent adverse clinical outcomes.

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Title: Predictors of rate-adaptive pacing in patients implanted with implantable cardioverter–defibrillator and subsequent differential clinical outcomes
Authors: Nils Källner
Marin Nishimura
Ulrika Birgersdotter-Green
Kurt S. Hoffmayer
Frederick T. Han
David E. Krummen
Farshad Raissi
Gregory K. Feld
Jonathan C. Hsu
Publication date: 01-06-2019
Publisher: Springer US
Keywords: Cardiomyopathy
Heart Failure
Atrial Fibrillation
Cardiac Resynchronization Therapy
Implantable Cardioverter Defibrillator
Implantable Cardioverter Defibrillator
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 1/2019
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-019-00536-9

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