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45/The incidence of new-onset atrial fibrillation in patients receiving cardiac resynchronisation therapy

European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr45

Background: In patients with heart failure (HF) and poor left ventricular function, atrial fibrillation (AF) is common, with approximately 2/3 of patients with HF over the age of 65 having AF. One form of treatment for patients with HF is cardiac resynchronisation therapy (CRT). With an ageing population, the prevalence of HF is only going to increase so the requirement of CRT as a form of treatment will also increase. Because patients with HF who develop AF have a worse outcome, it is of particular interest to try prevent AF. Identification of novel risk factors for new-onset AF in CRT patients will allow for improved early detection of AF.

Aim: To assess the incidence of new-onset AF in patients receiving CRT. In addition to this, we aim to identify novel risk factors for new-onset AF in CRT patients.

Methods: This is a single centre retrospective cohort study. Those with no known AF were included in the study. A variety of pre-admission test values were collected from electrocardiograms (ECG) and echocardiograms. Statistical analysis was then performed to identify the probability and recognise any factors which increased the likelihood of developing AF post-CRT implant.

Results: 25.9% of patients developed new-onset AF post CRT. Those who developed new-onset AF had a significantly lower (p=0.029) RA pacing percentage of 0.6 (0.0–99.9)%. Patients who developed new-onset AF had a significantly E/A than those with no AF (1.1 ms versus 0.8 ms; p=0.028).

Conclusion: E/A and RA pacing % are both known to contribute towards atrial remodelling. Prospective, multi-centre studies should be performed to determine if RA pacing can reduce the incidence of AF and in turn, reduce the likelihood of HF exacerbations and ultimately improve patients’ quality of life.

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