La Greca Carmelo, Dell'Aquila Andrea, Prezioso Amedeo, Bertini Matteo, Bianchi Valter, Vitulano Gennaro, Calò Leonardo, Savarese Gianluca, Santobuono Vincenzo Ezio, Dello Russo Antonio, Viscusi Miguel, Santoro Amato, Calvanese Raimondo, Pangallo Antonio, Amellone Claudia, Arena Giuseppe, Campari Monica, Valsecchi Sergio, Boriani Giuseppe, Pecora Domenico
Electrophysiology Unit, Cardiology Operating Unit, Fondazione Poliambulanza Hospital, Brescia, Italy.
Cardiology Unit, Sant'Anna University Hospital, University of Ferrara, Italy.
Int J Cardiol Heart Vasc. 2025 Jun 20;59:101731. doi: 10.1016/j.ijcha.2025.101731. eCollection 2025 Aug.
The HEAD2TOES schema was introduced to identify modifiable risk factors (RF) for atrial fibrillation (AF), including heart failure (HF), physical inactivity (PA), and sleep apnea (SA). Modern implantable cardioverter-defibrillators (ICDs) can detect SA, assess HF status, and measure daily PA. This study investigates the relationship between atrial high-rate episodes (AHREs) and ICD-detected surrogates for these RF in HF patients.
Data were collected from 411 HF patients with ICDs. The HeartLogic Index measured HF status, Respiratory Disturbance Index (RDI) severe SA (≥30episodes/hour), and accelerometer detected reduced PA (≥1 h/day). Endpoints were daily AHRE burdens ≥ 5 min and ≥ 23 h. Over 26 months of median follow-up, IN-alert-HF state was 13 % of the total observation time, RDI ≥ 30 episodes/h occurred 58 % of time, and 2 % of weekly activity values were ≥ 1 h lower than usual. AHRE burden ≥ 5 min/day occurred in 139 (34 %) patients and ≥ 23 h/day in 68 (17 %). Both IN-alert-state and reduced activity were independently associated with AHRE burden (≥5 min/day and ≥ 23 h/day), while RDI ≥ 30episodes/hour was associated only with AHRE ≥ 5 min/day. We defined a score predicting AHRE burden ≥ 5 min (2HeartLogic_IN-alert + 1RDI ≥ 30episodes/hour + 4Reduction_in_activity ≥ 1 h), and a score predicting AHRE burden ≥ 23 h (1HeartLogic_IN-alert + 2*Reduction_in_activity ≥ 1 h). Lower score levels (AHRE-5 min < 4 and AHRE-23 h < 2) comprised the largest proportion of follow-up duration (98 %), with higher scores linked to higher incidence rate ratios for AHRE (6.75 [95 %CI:1.88-20.16] and 11.46 [95 %CI:3.34-31.72], respectively).
In HF patients, AHRE occurrence is independently associated with ICD-detected HF status, severe SA, and decreased PA. These ICD-indexes might serve as surrogates for HEAD2TOES RF, aiding in continuous AF risk assessment.
引入HEAD2TOES模式以识别心房颤动（AF）的可改变风险因素（RF），包括心力衰竭（HF）、身体活动不足（PA）和睡眠呼吸暂停（SA）。现代植入式心脏复律除颤器（ICD）可检测SA、评估HF状态并测量每日PA。本研究调查HF患者中心房高率发作（AHREs）与ICD检测到的这些RF替代指标之间的关系。
收集了411例植入ICD的HF患者的数据。心脏逻辑指数测量HF状态，呼吸紊乱指数（RDI）用于检测严重SA（≥30次/小时），加速度计检测PA降低（≥1小时/天）。终点为每日AHRE负担≥5分钟和≥23小时。在中位随访26个月期间，IN-警报-HF状态占总观察时间的13%，RDI≥30次/小时发生的时间占58%，每周活动值中有2%比平常低≥1小时。139例（34%）患者出现每日AHRE负担≥5分钟，68例（17%）患者出现每日AHRE负担≥23小时。IN-警报状态和活动减少均与AHRE负担（≥5分钟/天和≥23小时/天）独立相关，而RDI≥30次/小时仅与AHRE≥5分钟/天相关。我们定义了一个预测AHRE负担≥5分钟的评分（2×心脏逻辑_IN-警报 + 1×RDI≥30次/小时 + 4×活动减少≥1小时），以及一个预测AHRE负担≥23小时的评分（1×心脏逻辑_IN-警报 + 2×活动减少≥1小时）。较低的评分水平（AHRE-5分钟<4且AHRE-23小时<2）占随访持续时间的最大比例（98%），评分越高，AHRE的发病率比值越高（分别为6.75[95%CI：1.88 - 20.16]和11.46[95%CI：3.34 - 31.72]）。
在HF患者中，AHRE的发生与ICD检测到的HF状态、严重SA和PA降低独立相关。这些ICD指标可能作为HEAD2TOES RF的替代指标，有助于持续的AF风险评估。
