Heart Failure with Preserved Ejection Fraction is a Highly Arrhythmogenic Disease

Abstract

Background Sudden cardiac death (SCD) is a relatively common mode of death in patients with heart failure preserved ejection fraction (HFpEF). However, the spectrum and burden of cardiac arrhythmias, particularly those of ventricular arrhythmias, has not well established in these patients. Methods We performed routine arrhythmia surveillance using a 14-day adhesive patch ambulatory ECG recorder (ZioPatch) in patients with HFpEF, enrolled in a subspecialty heart failure clinic. Cardiac electrophysiologists interpreted the ECG recordings. We extracted the clinical data from electronic medical records. Results A total of 40 patients (mean age 71.1±9.9 years, 53% women) with HFpEF underwent routine Ziopatch monitoring. Mean ejection fraction was 59.4±4.4% and 44% had history of coronary artery disease. Of the 40 patients, 32.5% had episodes of non-sustained ventricular tachycardia (VT) (mean 5±5.2 episodes), 15.0% had paroxysmal atrial fibrillation and 80.0% had episodes of supraventricular tachycardia during the monitored period. All patients had premature ventricular complexes (PVC) with 7.5% having a PVC burden that exceeded 5%. Patients with non-sustained VT had a relatively lower EF, higher NT-proBNP level and were more likely to be obese (Table). Conclusion Patients with HFpEF have a high, and possibly underappreciated, burden of cardiac arrhythmias. The frequent episodes of non-sustained VT in these patients may provide insight into the mechanism of SCD in HFpEF.