症状性心力衰竭患者中通过植入式心脏监测器识别的心律失常发生率

Incidence of Cardiac Arrhythmias Identified by Insertable Cardiac Monitors in Patients With Symptomatic Heart Failure.

作者信息

Kahwash Rami, Butler Javed, Khan Muhammad Shahzeb, Chalasani Prasad, Bertolet Barry, Gravelin Laura, Lambert Cameron, Sarkar Shantanu, Van Dorn Brian, Laechelt Aimee, Wehking Jennifer, Patel Nirav, Gerritse Bart, Laager Verla, Zile Michael R

机构信息

The Ohio State University, Columbus, Ohio, USA.

Baylor Scott and White Research Institute, Dallas, Texas, USA; University of Mississippi Medical Center, Jackson, Mississippi, USA.

出版信息

JACC Heart Fail. 2025 Aug;13(8):102527. doi: 10.1016/j.jchf.2025.102527. Epub 2025 Jul 1.

DOI:10.1016/j.jchf.2025.102527

PMID:40602175

Abstract

BACKGROUND

Cardiac bradyarrhythmias and tachyarrhythmias in chronic heart failure (CHF) patients are associated with increased morbidity and mortality. Insertable cardiac monitors provide a continuous, ambulatory, accurate monitoring strategy for patients with CHF who are not candidates for cardiac implantable electronic devices.

OBJECTIVES

This study aims to assess the occurrence of cardiac arrhythmias (CAs) in patients with CHF across the ejection fraction (EF) spectrum and not indicated for cardiac implantable electronic devices.

METHODS

Patients with recent heart failure events enrolled in LINQ-HF (Reveal LINQ Heart Failure) and Phase 1 ALLEVIATE-HF (Algorithm Using LINQ Sensors for Evaluation and Treatment of Heart Failure) studies were implanted with an insertable cardiac monitor. All CAs were adjudicated first using an artificial intelligence model, then manually verified, and grouped into 3 categories: atrial fibrillation (AF), ventricular tachycardia (VT) or fibrillation (VF), and bradycardia/pauses.

RESULTS

In total, 163 patients (mean age 67.2 ± 11.2 years, 62.6% male, 49.1% EF ≥50%, 83.4% Class III, 55.2% history of AF) were followed for 17.2 ± 9.8 months. Occurrence of AF was 59.7% at 2 years, 53.1% in heart failure with reduced ejection fraction (HFrEF) <50%, and 64.6% in heart failure with preserved ejection fraction (HFpEF) ≥50%. Incidence of AF in patients without prior AF was 23.8%, 23.9% in HFrEF, and 27.6% in HFpEF. Incidence of bradycardia or pause was 37.2% overall, (37.5% in HFrEF and 39.8% in HFpEF; 30.3% during daytime vs 19.4% during nighttime). Incidence of VT/VF was 14.3% overall, 19.8% in HFrEF, and 10.4%, in HFpEF.

CONCLUSIONS

In CHF patients undergoing ambulatory, continuous, accurate arrhythmia monitoring, the incidence of AF and bradycardia/pause events was high and similar in HFpEF vs HFrEF patients. VT/VF was lower in HFpEF than HFrEF, but clinically important.

摘要

背景

慢性心力衰竭（CHF）患者的心脏缓慢性心律失常和快速性心律失常与发病率和死亡率增加相关。可植入式心脏监测仪为不适合植入心脏植入式电子设备的CHF患者提供了一种连续、动态、准确的监测策略。

目的

本研究旨在评估射血分数（EF）范围内且不适合植入心脏植入式电子设备的CHF患者心律失常（CA）的发生情况。

方法

纳入LINQ-HF（Reveal LINQ心力衰竭）和1期ALLEVIATE-HF（使用LINQ传感器评估和治疗心力衰竭的算法）研究的近期发生心力衰竭事件的患者植入可植入式心脏监测仪。所有CA首先使用人工智能模型进行判定，然后人工验证，并分为3类：心房颤动（AF）、室性心动过速（VT）或颤动（VF）以及心动过缓/停搏。

结果

总共163例患者（平均年龄67.2±11.2岁，男性占62.6%，49.1%的EF≥50%，83.4%为Ⅲ级，55.2%有AF病史）接受了17.2±9.8个月的随访。AF的发生率在2年时为59.7%，射血分数降低的心力衰竭（HFrEF）<50%的患者中为53.1%，射血分数保留的心力衰竭（HFpEF）≥50%的患者中为64.6%。既往无AF患者的AF发生率为23.8%，HFrEF患者中为23.9%，HFpEF患者中为27.6%。心动过缓或停搏的总发生率为37.2%（HFrEF中为37.5%，HFpEF中为39.8%；白天为30.3%，夜间为19.4%）。VT/VF的总发生率为14.3%，HFrEF中为19.8%，HFpEF中为10.4%。