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INTRINSIC RV: New AF in patients with ICDs a risk marker for higher mortality

Issue: March 2009

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Newly detected atrial fibrillation in patients who have implantable cardioverter defibrillators may be associated with increased mortality, study results suggested.

The researchers examined data for 1,530 patients enrolled in the INTRINSIC RV trial. Each patient received a dual-chamber ICD between 2003 and 2004. Among the 1,530 patients with ICDs, 1,356 (89%) had no history of AF at the time of device implant. With proportional hazard models, the researchers then retrospectively analyzed the relationship between AF and the primary endpoints of total mortality, ICD shocks and HF hospitalization.

According to the results, patients with a history of AF had a higher prevalence of HF (52% vs. 36%; P<.01) as well as higher rates of death (HR=2.22; 95% CI, 1.26-3.92), HF hospitalization (HR=2.14; 95% CI, 1.29-3.54), HF hospitalization or death (HR=1.96; 95% CI, 1.29-2.99) and ICD shock (HR=1.75; 95% CI, 1.19-2.58) compared with patients with no history of AF. The researchers also reported that newly detected AF in those with ICDs and no history of AF was associated with an increased risk for death (HR=2.86; 95% CI, 1.02-8.05).

“Newly detected AF is associated with significantly higher rates of death in excess of those with a prior history of AF,” the researchers wrote. “The relationship between newly detected AF and inappropriate ICD shock or HF hospitalization is uncertain and remains an area of continued exploration.” – by Eric Raible

Heart Rhythm. 2009;6:2-8.

First, AF as a predictor for poor outcome is not new and has been shown in trials before, as reviewed by Bunch et al. Second, it will not change practice since one cannot predict who will get AF after an ICD is implanted. As such, the future “maybe” will not change what is done today. Note reference from Goldenberg et al (J Am Coll Cardiol. 2008;51:288-296) and secondarily Buxton et al (J Am Coll Cardiol. 2007;50:1150-1157) that show problem of AF.

– Andrew Epstein, MD

Cardiology Today Editorial Board member