Background: Atrial fibrillation (AF) outcomes are strongly associated with continuous measures of AF burden.

Objectives: Assess the association between changes in maximum daily AF duration (MDAFD) and stroke or mortality in patients with cardiac implantable electronic devices (CIEDs).

Methods: The Optum® de-identified electronic health record dataset (EHR) (2007-2021) was linked with the Medtronic CareLink® heart rhythm database. Patients with CIEDs and healthcare activity recorded in the EHR were included, excluding those with oral anticoagulation (OAC) prescription. MDAFD was assessed 30-days post-implant (baseline period) and 30-days prior to censoring or an event. Hazard ratios for the primary analysis were adjusted for components of CHA2DS2-VASc, baseline MDAFD category and chronic kidney disease.

Results: Of 26,400 patients (68±13 years; follow-up 2.6±1.6 years) analyzed, 2,544 (9.6%) had AF during baseline. Increased (vs. stable or decreased) MDAFD in follow-up was associated with a higher adjusted rate of stroke and mortality (HR 1.80 [1.61-2.01]). There was no association between decreased MDAFD in follow-up and the combined endpoint (HR 0.82 [0.68-1.00]). Subgroup analysis by baseline MDAFD category demonstrated that increased MDAFD in follow-up was associated with a greater risk of stroke or mortality among patients with no AF at baseline, and decreased MDAFD in follow-up was associated with a lower risk of stroke or mortality among patients with baseline MDAFD 1hour-<5.5hours and 5.5hours-<23.5hours.

Conclusions: In CIED patients not on OAC, increased MDAFD in follow-up was associated with a higher rate of stroke and mortality. These results suggest that AF burden, and associated risk, is not stable over time.

Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
 
CME Editor
Kenneth A. Ellenbogen, MD, FACC

Author
Kelvin Bush, MD, FACC


Important Dates
Date of Release: November 25, 2024
Term of Approval/Date of CME/MOC Expiration: November 24, 2025