Left ventricular diastolic dysfunction predicts new-onset atrial cardiomyopathy in patients with insertable cardiac monitors
H Sumiyoshi, A Mizukami, A Nakashima, T Shinozaki, R Nakada, T Kono, M Ono, D UeshimaAbstract
Background
Atrial fibrillation (AF) and sick sinus syndrome (SSS) are increasingly recognized as clinical phenotypes of atrial cardiomyopathy (AtCM). Although left ventricular (LV) diastolic dysfunction frequently coexists with AF, its role in the de novo development of AtCM remains unclear.
Purpose
To investigate whether LV diastolic dysfunction, assessed by the HFA-PEFF score, is associated with the development of new-onset SSS and AF in patients without prior AF undergoing insertable cardiac monitor (ICM) implantation for unexplained syncope.
Methods
We retrospectively analyzed 164 patients (median age 71 years, 34% women) who underwent ICM implantation for recurrent unexplained syncope and had no prior AF. LV diastolic dysfunction was assessed using the HFA-PEFF score. Patients were followed for up to 36 months with continuous remote rhythm monitoring. The primary endpoints were new-onset SSS requiring pacemaker implantation and AF episodes lasting ≥6 minutes.
Results
During a median follow-up of 35 months, SSS occurred in 31 patients (18.9%) and AF ≥6 minutes in 48 patients (29.3%). Patients with high HFA-PEFF scores (5–6) had a significantly higher risk of developing both SSS and AF (Figure 1). The HFA-PEFF score was independently associated with SSS (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.07–2.13; p=0.021) and AF ≥6 minutes (HR 1.94, 95% CI 1.40–2.67; p<0.001) after multivariable adjustment. No significant association was observed between the HFA-PEFF score and atrioventricular block or atrial tachyarrhythmias other than AF.
Conclusions
LV diastolic dysfunction assessed by the HFA-PEFF score is independently associated with the de novo development of SSS and AF in AF-naïve patients undergoing ICM implantation for unexplained syncope. These findings support a mechanistic link between LV diastolic dysfunction and early atrial cardiomyopathy.Figure 1