Background: Atrial and ventricular tachyarrhythmias,
including atrial fibrillation (AF) as well as bradyarrhythmias have been well
documented in elderly and generally symptomatic patients with heart failure
(HF) and/or hypertension (HTN), most often using 24 hour continuous monitoring.
However, the frequency of these arrhythmias, including silent as well as
symptomatic, as assessed by more prolonged monitoring, the relationship between
symptoms in patients with HF and/or HTN and an underlying arrhythmia, and the
association of arrhythmias including those that are silent with subsequent
cardiac events has not been well defined in patients 65 years or older with HF
and other cardiovascular risk factors. Importantly in such patients, AF, even
if symptomatic, would yield a CHADS2 score indicative of
pilot study to assess the potential value of 2 weeks of out-patient, transtelephonic
cardiac auto-triggered loop-monitoring for detecting arrhythmias, assessing
their relationship to symptoms, predicting the risk of subsequent cardiac
events, and determining if they result in therapy in an elderly, urban population
living with HF.
subjects with a history of systolic HF and/or HTN consented to wear an auto
triggered cardiac loop monitor for 2 weeks. This device captures EKG data, including silent and symptomatic
arrhythmias. Subjects were requested to
transmit data once daily as well as to transmit if they were symptomatic to
determine if an underlying dysrhythmia was present.
age was 73 ± 6 years with 59% were female, 74% Hispanic, 22% black, and 4%
white/other. All subjects had HF and 94% had HTN; all were in sinus rhythm at
the time of enrollment. From the cardiac monitoring, 72% demonstrated ectopic atrial
and ventricular activity. In addition, 1 paroxysmal episode of AF was
documented, 3 people had significant non-sustained ventricular tachycardia that
contributed to the placement of an internal cardioverter defibrillator (ICD), and
4 individuals underwent subsequent placement of a pacemakers for severe bradycardia/heart
block (per established guidelines). The
relationship between arrhythmia and symptoms was weak. These events would have otherwise gone undetected and untreated. During follow-up, 15 subjects (28%) had
significant cardiac events, including one patient with a non ST segment
myocardial infarction (NSTEMI) infarct due to undetected and untreated AF and
one patient with symptomatic 2:1 atrial flutter. The AF and flutter patients
all had CHADS2 scores appropriate for initiation of anticoagulation.
substantial proportion of subjects exhibited arrhythmias during monitoring,
cardiac events during follow-up and consequent therapy. This approach to arrhythmia screening appears
to have sufficient merit to warrant further study.
Credits: Kathleen T. Hickey; James Reiff el; Robert R. Sciacca; William Whang; Angelo Biviano; Mau-rita Baumeister; Carmen Castillo; Jyothi Talathothi; Hasan Garan