論文種別	原著(症例報告除く)
言語種別	英語
査読の有無	その他(不明)
表題	Etiology-Dependent Prognostic Impact of Atrial Fibrillation in ICD and CRT Recipients.
掲載誌名	正式名：Heart rhythm 略　 称：Heart Rhythm ISSNコード：15563871/15475271
掲載区分	国外
巻・号・頁	pp.Online ahead of print
著者・共著者	Taro Temma, Hisashi Yokoshiki, Takeshi Mitsuhashi, Kohei Ishibashi, Tomoyuki Kabutoya, Yasuhiro Yoshiga, Yusuke Kondo, Akihiko Shimizu, Masahiko Takagi, Hiroshi Tada
発行年月	2026/07
概要	BACKGROUND:Atrial fibrillation (AF) is a common comorbidity in patients receiving implantable cardiac defibrillators (ICD) or cardiac resynchronization therapy (CRT) and is associated with increased mortality. However, most evidence comes from Western cohorts dominated by ischemic cardiomyopathy (ICM), limiting applicability to populations in which non-ischemic cardiomyopathy (NICM) is more prevalent. Because NICM and ICM differ fundamentally in myocardial pathology and remodeling, the prognostic impact of AF may not be uniform across etiologies.OBJECTIVES:This study aimed to determine whether the prognostic impact of AF differs between NICM and ICM in ICD/CRT patients METHODS: We analyzed data from 4,623 patients in a nationwide cardiac device registry. Outcomes were all-cause death, cardiac death, heart failure hospitalization, and ICD therapies. Multivariable Cox and Fine-Gray competing risk models were constructed using literature-based, MAGGIC-derived, and stepwise covariate selection strategies. Propensity score matching (PSM) was performed within ICM and NICM subgroups.RESULTS:AF was associated with higher risks of mortality, cardiac death, and heart failure hospitalization in NICM across all models. In contrast, the association between AF and mortality in ICM was attenuated and no longer statistically significant after multivariable adjustment. After PSM, AF remained associated with increased mortality in NICM but not in ICM. AF impact for rates of ICD therapies did not differ between etiologies.CONCLUSIONS:The prognostic impact of AF among ICD/CRT recipients differs markedly by cardiomyopathy etiology. AF identifies a high-risk subgroup within NICM, whereas its effect is attenuated in ICM. Etiology-specific risk assessment should be incorporated into clinical management.
DOI	10.1016/j.hrthm.2026.06.039
PMID	42392471