Khan Muhammad Shahzeb, Zile Michael R, Kahwash Rami, Sarkar Shantanu, Van Dorn Brian, Koehler Jodi, Franco Noreli, Gerritse Bart, Butler Javed
Baylor Scott and White Research Institute, Dallas, Texas, USA.
Baylor College of Medicine, Temple, Texas, USA.
ESC Heart Fail. 2025 Jun;12(3):1693-1702. doi: 10.1002/ehf2.15180. Epub 2024 Dec 9.
We aim to evaluate the incidence of atrial fibrillation (AF) in a large real-world cohort of patients implanted with an insertable cardiac monitor (ICM) who had a clinical history of symptomatic heart failure (HF) with reduced or preserved left ventricular ejection fraction (LVEF).
Patients with an ICM and a history of HF events were identified from the Optum® de-identified Electronic Health Record dataset merged with an ICM device dataset collected during 2007-2021. All ICM-detected AF episodes that were available with ≥30-s of ECG at onset were adjudicated using artificial intelligence (AI model). Episodes with AI model probability of AF ≥ 0.9 were analysed. The Kaplan-Meier incidence of AF as a function of episode duration, history of AF, and LVEF were assessed.
A total of 1020 patients with ICM were identified of whom 911 had ≥180 days of follow-up and were included. According to the AI model, 358 patients had 8407 episodes of true AF. Incidence of AF at 42 months was 45.6% (44.1% vs. 46.8% in reduced vs. preserved LVEF). Incidence of new-onset AF was 23.2% (23.3% vs. 22.2% in reduced vs. preserved LVEF) in patients with no clinical history of AF. Patients with new-onset AF had a higher HF event rate compared with patients who had no clinical history of AF and did not develop AF during follow-up [OR = 2.73 (1.47-5.09); P = 0.002]. Patients with preserved LVEF had more longer duration paroxysmal AF compared with those with reduced LVEF (44.5% vs. 33.9%, P = 0.02).
AF was observed in almost half of patients with ICM and symptomatic HF. One-fourth of the patients had new onset AF and a higher rate of HF events compared with patients without AF. AF incidence was similar in patients with preserved and reduced LVEF.
我们旨在评估在植入可插入式心脏监测器（ICM）且有症状性心力衰竭（HF）病史、左心室射血分数（LVEF）降低或保留的大型真实世界患者队列中房颤（AF）的发生率。
从与2007 - 2021年期间收集的ICM设备数据集合并的Optum®去识别电子健康记录数据集中识别出有ICM且有HF事件病史的患者。对所有在发作时心电图记录时长≥30秒的ICM检测到的AF发作，使用人工智能（AI模型）进行判定。分析AI模型判定AF概率≥0.9的发作情况。评估AF的Kaplan - Meier发生率与发作持续时间、AF病史和LVEF的关系。
共识别出1020例植入ICM的患者，其中911例有≥180天的随访并被纳入研究。根据AI模型，358例患者发生了8407次真正的AF发作。42个月时AF的发生率为45.6%（LVEF降低组与保留组分别为44.1%和46.8%）。在无AF临床病史的患者中，新发AF的发生率为23.2%（LVEF降低组与保留组分别为23.3%和22.2%）。与无AF临床病史且随访期间未发生AF的患者相比，新发AF患者的HF事件发生率更高[比值比（OR）=2.73（1.47 - 5.09）；P = 0.ooo2]。与LVEF降低的患者相比，LVEF保留的患者阵发性AF持续时间更长（44.5%对33.9%，P = 0.02）。
在几乎一半植入ICM且有症状性HF的患者中观察到AF。与无AF患者相比，四分之一的患者发生新发AF且HF事件发生率更高。LVEF保留和降低的患者中AF发生率相似。
