Atrial fibrillation is a predictor of ventricular tachyarrhythmias and sudden cardiac death in de novo heart failure

Clin Res Cardiol (2026). DOI 10.1007/s00392-026-02870-1
L. Wloch (Bochum)¹, A. Horsthemke (Bochum)¹, K. Koepsel (Bochum)¹, T. Beiert (Bonn)², B. Kovacs (Zürich)³, T. Dreher (Mannheim)⁴, C. Blockhaus (Krefeld)⁵, N. Klein (Leipzig)⁶, T. Kuntz (Leipzig)⁶, H. Lapp (Bonn)⁷, D.-I. Shin (Krefeld)⁵, C. Ukena (Herne)⁸, J. Wintrich (Herne)⁸, A. M. Saguner (Zürich)⁹, J. W. Erath-Honold (Frankfurt am Main)¹⁰, F. Duru (Zürich)³, A. Mügge (Lüdinghausen)¹¹, A. Aweimer (Bochum)¹², L. M. Hoffmann (Mannheim)¹³, M. Abumayyaleh (Mannheim)¹⁴, I. Akin (Mannheim)¹⁴, C. Weth (Saarbrücken)¹⁵, F. Custodis (Saarbrücken)¹⁵, W. Schehab (Meppen)¹⁶, N. Hamdani (Bochum)¹⁷, I. El-Battrawy (Bochum)^18
1Ruhr-Universität Bochum Bochum, Deutschland; ²Herzzentrum des Universitätsklinikums Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland; ³Universitätsspital Zürich Klinik für Kardiologie Zürich, Schweiz; ⁴Universitätsklinikum Mannheim I. Medizinische Klinik Mannheim, Deutschland; ⁵HELIOS Klinikum Krefeld Medizinische Klinik I Krefeld, Deutschland; ⁶Klinikum Sankt Georg Klinik für Kardiologie, Angiologie und intern. Intensivmedizin Leipzig, Deutschland; ⁷Universitätsklinikum Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland; ⁸Marienhospital Herne, Klinikum der Ruhr-Universität Bochum Med. Klinik II, Kardiologie u. Angiologie Herne, Deutschland; ⁹Universitätsspital Zürich Universitäres Herzzentrum Zürich, Schweiz; ¹⁰Universitätsklinikum Frankfurt Med. Klinik III - Kardiologie, Angiologie Frankfurt am Main, Deutschland; ¹¹Lüdinghausen, Deutschland; ¹²Berufsgenossenschaftlliches Universitätsklinikum Bergmannsheil gGmbH Medizinische Klinik II, Kardiologie und Angiologie Bochum, Deutschland; ¹³Klinikum Mannheim GmbH,Universitätsklinikum, Medizinische Fakultät Mannheim der Universität Heidelberg Mannheim, Deutschland; ¹⁴Universitätsklinikum Mannheim GmbH I. Medizinische Klinik Mannheim, Deutschland; ¹⁵Klinikum Saarbrücken gGmbH Medizinische Klinik II Saarbrücken, Deutschland; ¹⁶Krankenhaus Ludmillenstift Innere Medizin, Kardiologie, Pneumologie, Angiologie und internistische Intensivmedizin Meppen, Deutschland; ¹⁷Kath. Klinikum Bochum Cellular Physiology Bochum, Deutschland; ¹⁸Klinikum der Ruhr-Universität Bochum Medizinische Klinik II, Kardiologie Bochum, Deutschland

Background. It was observed that atrial fibrillation (AF) may contribute to a further decline in left ventricular ejection fraction (LVEF) among patients with de novo heart failure with reduced LVEF. However, there remains limited evidence regarding the association between AF and the occurrence of ventricular tachyarrhythmias and sudden cardiac death (SCD) in patients with de-novo reduced HFrEF. The objective of this analysis was to evaluate the association between AF and the incidence of ventricular tachyarrhythmias and SCD in patients suffering from de-novo HFrEF using data from wearable cardioverter defibrillator (WCD) database.

Methods. We recruited 1062 patients from an international multicenter WCD registry across nine European centers, including 288 patients with a history of AF and 774 without a history of AF. Patients were followed for 3 months (short-term) and 6 to 12 months (long-term).

Results. Patients with a history of AF were older compared to non-AF patients (mean + SD 63.98 ± 11.52 vs. 56.82 ± 13.27 years; p<0.001). The proportion of females was lower in the AF group (43 patients, 14.9%) compared to the non-AF group (161 patients, 20.8%; p = 0.033). The duration of use for the WCD was comparable in both groups (AF-group 62.97 ± 44.36 days vs. non-AF 65.78 ± 46.36 days). The rate of ventricular tachyarrhythmias was higher among AF patients compared to non-AF patients (ventricular tachyarrhythmias 12.8% vs. 7.6%; p=0.007, ventricular fibrillation (VF) 1.7% vs. 0.5%, sustained ventricular tachycardia (VT) 4.9% versus 4.3%, non-sustained VT 6.3% vs. 2.8%). Similarly, the rate of appropriate WCD shocks was higher in AF patients than in non-AF patients (3.1% versus 1.3%; p=0.04).

The mortality rate was similar in AF-patients (9.8%) compared to non-AF-patients (7.1%); (p=0.162). The rate of re-hospitalization was marginally higher in AF patients (41.1%) compared to non-AF patients (31.9%) (p=0.08). In the multivariate cox-regression analysis, improved LVEF reduced the rate of ventricular tachyarrhythmias (HR 0.354; 95% CI 0.184-0.679; p=0.002) whereas a history of AF significantly increased the risk of sustained VT/VF events (HR 1.661; 95%CI 1.060-2.605; p=0.027).

Conclusions. AF was identified as a predictor of ventricular tachyarrhythmias among patients suffering from de novo reduced LVEF.