Effect of Atrial High-Rate Episodes (AHRE) on the Response to Cardiac Resynchronization Therapy (CRT) in Heart Failure Patients with Reduced Ejection Fraction (HFrEF)

Abstract Aim and Objectives To evaluate the burden and impact of AHRE on the functional capacity and quality of life of HFrEF patients treated with CRT. Patients and Methods This study included a group of 100 HFrEF patients treated with CRT who came for regular follow up at electrophysiology clinic. Device interrogation was done to assess the burden of AHRE, followed by assessment of functional capacity using the standard 6-minute walk test and assessment of quality of life using the Minnesota living with heart failure questionnaire. Results There was no statistically significant correlation between AHRE prevalence and distance walked during 6MWT, however, when compared to the distance expected for an equivalent healthy individual, there was a highly statistically significant difference (82.02±17.22% in non-AHRE group vs. 75.15±15.78% in AHRE group, P-Value <0.001). As regards the quality of life, there was a statistically significant correlation between the prevalence of AHRE and the total MLHFQ score (mean score of 36.97±7.76 in non-AHRE group vs 46.76±9.82 in AHRE group, P-value 0.032), however there was no statistically significant correlation with QoL class (28.8% poor QoL in non-AHRE group vs 50% in AHRE group, P-value 0.09). Conclusion AHRE is associated with a significant decline in functional status and perceived quality of life in HFrEF patients treated with CRT. Presence of AHRE longer than 5 minutes during CRT interrogation at least 6 months after implantation was associated with a poorer performance on 6MWD as well as a higher MLHFQ score denoting a decline in perceived quality of life.