Abstract 13449: Patient-Triggered Symptomatic Events Poorly Predict Presence of Atrial Arrhythmia on Ambulatory Electrocardiogram Monitors in Heart Failure Patients

Abstract

Introduction: Emerging evidence supports more aggressive rhythm control of atrial fibrillation (AF) among heart failure (HF) patients. Yet, the impact of AF on symptom status in HF and the relationship to rate control have not been well studied in the setting of prolonged, ambulatory monitoring. Hypothesis: Patient-triggered symptomatic events (PTSEs) can predict the simultaneous presence of atrial tachycardia/AF (ATAF) on cardiac event monitors(CEM) among HF patients with documented atrial arrhythmia. Methods: All UHealth HF patients with at least 1 ATAF event over ≥7 days on CEMs were retrospectively reviewed. Tetrachoric correlation analysis between PTSEs and ATAF events and t-tests of mean heart rates(HR) were performed. Results: A total of 3,162 events were analyzed among 185 HF patients. The mean age was 68 years and 43% were female; 61% had CAD; the mean ejection fraction was 54% (SD 16%); and 74% were on beta-blockers. There were 2347 ATAF events, 1031 PTSEs, and 216 symptomatic ATAF events. Of PTSEs, 21.0% were ATAF, and of ATAF events, 9.2% were symptomatic. Overall mean HR of PTSEs was 94bpm (SD 29), lower than asymptomatic events, 103bpm (SD 29, p<0.001). Mean HR of symptomatic ATAF events was 117bpm (SD 35), compared with asymptomatic ATAF (110bpm, SD 31, p=0.008). See Figure 1. PTSEs were less likely to predict simultaneous ATAF compared to sinus rhythm, with a moderate inverse tetrachoric correlation of -0.69 (bootstrapped 95% CI -0.65, -0.72). Conclusion: Among patients with AF & HF, symptoms are a poor marker of atrial arrhythmia. PTSEs on ambulatory monitoring are not correlated with ATAF events in a clinically meaningful association and are not adequately explained by the heart rate differences. Classic symptom-based treatment of AF and HF should give way to more comprehensive quality-of-life and substrate guides for therapy.