Background: Atrial fibrillation is associated with increased morbidity and mortality in the general population. Atrial fibrillation outcome in significantly depressed LV function implanted with ICD and CRTD is limited.
Objective: To assess the prevalence and outcome of atrial fibrillation in this selective group in large cohort of patients enrolled in the Israeli ICD Registry.
Methods: A total of 1482 patients listed in the Israeli ICD registry were included in the study. Patients were categorized into 2 groups: with and without atrial fibrillation (n=306 (22%) and 1176 (78%), respectively). The mean follow up was 317 days.
Results: Patients with atrial fibrillation were older (67.8 vs 63.5 years, p<0.001), had less CAD (69% vs 76%, p=0.019), had more heart failure (85% vs 76%, p<0.001) and wider QRS complex (126.7 vs 118.5 msec, p<0.001). Patients with atrial fibrillation had higher mortality rate (9.48% versus 4.25%, p<0.0001), more frequent admissions for heart failure (11.85% versus 7.24%, p<0.0001) and higher rate of both appropriate (9.23% versus 6.30%, p=0.0152) and inappropriate (4.43% vs 2.16%, p=0.0184) shocks. In multivariate analysis, atrial fibrillation was associated with death (HR=1.852, CI 1.392-2.464, p<0.0001), but not heart failure. Similarly, it was associated with the presence of appropriate (HR=1.558, CI 1.0418-2.314, p<0.0283), but not inappropriate shocks.
Conclusion: Atrial fibrillation affects 22% of the ICD/CRTD recipients. Atrial fibrillation is a significant independent predictor of mortality and appropriate shocks in this group.
