Heart failure & cardiomyopathies
Atrial Fibrillation Burden and Atrial Shunt Therapy in Heart Failure With Preserved Ejection Fraction
Authors' conclusion
In HFpEF and HFmrEF, nearly 40% of patients have subclinical AF by 1 year. Baseline AF burden, even at low levels, is associated with HF events. Atrial shunt therapy does not affect AF incidence or burden.
Study context
- Population
- Patients with heart failure with preserved ejection fraction (HFpEF) or heart failure (HF) with mildly reduced EF (heart failure with mildly reduced ejection fraction (HFmrEF)) in a randomised trial of atrial shunt therapymonitoring at baseline and follow-up
- Participants
- 367 patients
- Comparison
- Baseline atrial fibrillation (AF) burden ≥0.012% vs lower; atrial shunt therapy effect on AF burden
- Primary endpoint
- AF burden (ambulatory cardiac patch monitoring) and association of baseline AF burden with HF events
- Follow-up
- 12-month follow-up
Methodological detailsMedian patch wear time 6 days at baseline, 125 days over follow-up
- Median patch wear time 6 days at baseline, 125 days over follow-up
Primary result
As reported in the abstract
HF events by baseline AF burden
AF burden ≥0.012% vs AF burden <0.012%Hazard ratio (95% CI)P value
Multivariable adjusted
2.00(1.17–3.44)
P = 0.01Further adjusted for LA reservoir strain
1.71(0.93–3.14)
P = 0.08- Median baseline AF burden
- 0.012% (IQR: 0%-1.3%)
- History of AF or atrial flutter
- 194 (53%)
Further findings
Patch-detected AF during follow-up without history of AF or AFL
- Patch-detected new AF
- 141 (38%)
Effect of atrial shunt therapy on AF
- Atrial shunt therapy did not change AF incidence or burden during follow-up
Original publication
Atrial Fibrillation Burden and Atrial Shunt Therapy in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail. Published 19 July 2023. doi:10.
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