DOI: 10.1093/europace/euad261 ISSN:

Performance of a multisensor implantable defibrillator algorithm for HF monitoring in the presence of atrial fibrillation.

Giuseppe Boriani, Matteo Bertini, Michele Manzo, Leonardo Calò, Luca Santini, Gianluca Savarese, Antonio Dello Russo, Vincenzo Ezio Santobuono, Carlo Lavalle, Miguel Viscusi, Claudia Amellone, Raimondo Calvanese, Amato Santoro, Antonio Rapacciuolo, Matteo Ziacchi, Giuseppe Arena, Jacopo F Imberti, Monica Campari, Sergio Valsecchi, Antonio D’Onofrio
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine



The HeartLogic Index combines data from multiple implantable cardioverter defibrillators (ICD) sensors and has been shown to accurately stratify patients at risk of heart failure (HF) events. We evaluated and compared the performance of this algorithm during sinus rhythm and during long-lasting atrial fibrillation (AF).

Methods and Results

HeartLogic was activated in 568 ICD patients from 26 centers. We found periods of ≥30 consecutive days with an atrial high-rate episode (AHRE)-burden <1 hour/day, and periods with an AHRE-burden ≥20 hours/day. We then identified patients who met both criteria during follow-up (AHRE group, N = 53), to allow pairwise comparison of periods. For control purposes, we identified patients with an AHRE-burden <1 h throughout their follow-up and implemented 2:1 propensity score matching versus the AHRE group (Matched non-AHRE group, N = 106). In the AHRE group, the rate of alerts was 1.2 (95%CI:1.0-1.5)/patient-year during periods with an AHRE-burden <1 hour/day and 2.0 (95%CI:1.5-2.6)/patient-year during periods with an AHRE-burden ≥20 hours/day (p = 0.004). The rate of HF hospitalizations was 0.34 (95%CI:0.15-0.69)/patient-year during IN-alert periods and 0.06 (95%CI:0.02-0.14)/patient-year during OUT-of-alert periods (p < 0.001). The IN/OUT-of-alert state incidence rate ratio of HF hospitalizations was 8.59 (95%CI:1.67-55.31) during periods with an AHRE-burden <1 hour/day and 2.70 (95%CI:1.01-28.33) during periods with an AHRE-burden ≥20 hours/day. In the Matched non-AHRE group, the rate of HF hospitalizations was 0.29 (95%CI:0.12-0.60)/patient-year during IN-alert periods, and 0.04 (95%CI:0.02-0.08)/patient-year during OUT-of-alert periods (p < 0.001). The incidence rate ratio was 7.11 (95%CI:2.19-22.44).


Patients received more alerts during periods of AF. The ability of the algorithm to identify increased risk of HF events was confirmed during AF, despite a lower IN/OUT-of-alert incidence rate ratio in comparison with non-AF periods and non-AF patients.

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