Prior History of Atrial Fibrillation and Arrhythmic Outcomes - Data from
the WEARIT-II Prospective Registry
Abstract
Introduction: Wearable Cardioverter Defibrillator (WCD) is
utilized in patients with assumed but not yet confirmed risk for sudden
cardiac death (SCD). Many of these patients also present with atrial
fibrillation (AF). However, the rate of WCD-detected ventricular or
atrial arrhythmia events in this specific high-risk cohort is not well
understood. Methods: In WEARIT-II, the cumulative probability
of any sustained or non-sustained VT/VF (WCD-treated and non-treated),
and atrial/supraventricular arrhythmias during WCD use was assessed
using the Kaplan-Meier method by prior AF, with comparisons by the
log-rank test. The incidence of ventricular and atrial arrhythmia events
were expressed as events per 100 patient-years, and were analyzed by
prior AF using negative binomial regression. Results: WEARIT-II
enrolled 2000 patients, 557 (28%) of whom had AF prior to enrollment.
Cumulative probability of any sustained or non-sustained WCD-detected
VT/VF during WCD use was significantly higher among patients with a
history of AF than without AF (6% vs. 3%, p=0.001). Similarly, the
recurrent rate of any sustained or non-sustained VT/VF was significantly
higher in patients with prior AF vs. no prior AF (131.5 events per 100
patient-years vs. 22.7 events per 100 patient-years, p=0.001). Patients
with prior AF also had a significantly higher burden of any WCD-detected
atrial arrhythmias/SVT/inappropriate therapy (183.2 events per 100
patient-years vs. 74.8 events per 100 patient-years, p<0.001).
Conclusion: Our results demonstrate that patients with a
history of AF wearing the WCD for risk assessment have a higher
incidence of ventricular arrhythmias that may facilitate the decision
making for ICD implantation.