Chest

Chest

Volume 118, Issue 4, October 2000, Pages 914-922
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Clinical Investigations
CARDIOLOGY
Incidence, Predictive Factors, and Prognostic Significance of Supraventricular Tachyarrhythmias in Congestive Heart Failure

https://doi.org/10.1378/chest.118.4.914Get rights and content

Background:

The incidence, predictive factors, morbidity, and mortality associated with the development of supraventricular tachyarrhythmias (SVTs) in patients with congestiveheart failure (CHF) are poorly defined.

Methods:

Inthe Digitalis Investigation Group trial, patients with CHF who were insinus rhythm were randomly assigned to digoxin (n = 3,889) or placebo(n = 3,899) and followed up for a mean of 37 months. Baseline factorsthat predicted the occurrence of SVT and the effects of SVT on totalmortality, stroke, and hospitalization for worsening CHF weredetermined.

Results:

Eight hundred sixty-six patients(11.1%) had SVT during the study period. Older age (odds ratio [OR],1.029 for each year increase in age; p = 0.0001), male sex (OR,1.270; p = 0.0075), increasing duration of CHF (OR, 1.003 for eachmonth increase in duration of CHF; p = 0.0021), and a cardiothoracicratio of > 0.50 (OR, 1.403; p = 0.0001) predicted an increased riskof experiencing SVT. Left ventricular ejection fraction, New York HeartAssociation functional class, and treatment with digoxin vs placebowere not related to the occurrence of SVT. After adjustment for otherrisk factors, development of SVT predicted a greater risk of subsequenttotal mortality (risk ratio [RR] = 2.451; p = 0.0001), stroke(RR = 2.352; p = 0.0001), and hospitalization for worsening CHF(RR = 3.004; p = 0.0001).

Conclusion:

In CHFpatients in sinus rhythm, older age, male sex, longer duration of CHF, and increased cardiothoracic ratio predict an increased risk forexperiencing SVT. Development of SVT is a strong independent predictorof mortality, stroke, and hospitalization for CHF in this population. Prevention of SVT may prolong survival and reduce morbidity in CHFpatients.

Section snippets

Eligibility and Randomization

Details of rationale, design, baseline characteristics, and mainoutcome of the DIG study have been publishedpreviously.56 The DIG study was a large, simpledouble-blind, placebo-controlled clinical trial on the effect of digoxin on mortality and hospitalization in heart failure. Briefly, patients with CHF who were in sinus rhythm at baseline were eligiblefor enrollment. Patients with CHF and a left ventricular ejectionfraction of ≤ 0.45 (n = 6,800) were enrolled into the main trial;patients with

Results

Table 1summarizes the baseline characteristics of the total DIG study cohortand compares these characteristics in the subset that experienced SVTwith those of the remaining patients (sample sizes for the currentanalysis were slightly lower because of missing values, but thebaseline percentages were unchanged). Patients who had SVT were olderand had a longer duration of CHF. A greater proportion of patients whoexperienced SVT had a cardiothoracic ratio > 0.50 and were in NYHAfunctional class

Incidence and Risk Factors for SVT

To our knowledge, no previous studies have prospectivelydetermined the incidence and risk factors for developing SVT in a largecohort of CHF patients who were in sinus rhythm at baseline. In thecurrent study, the incidence of SVT in a large heterogeneous populationof patients with CHF during a 3-year period was 11%. Older age, malesex, longer duration of CHF, and an enlarged heart predicted asignificantly increased risk of this complication in patients with CHF. These results parallel in part

Conclusion

In a large, heterogeneous population of patients with CHF andsinus rhythm, older age, male sex, longer duration of CHF, andincreased cardiothoracic ratio are significant risk factors for thedevelopment of SVT. Development of SVT in patients with CHF is a strongand independent predictor of death, stroke, and hospitalization forworsening CHF. Treatment with digoxin does not reduce the risk of development of SVT in patients with CHF. Further studies to determinethe effect of interventions to

ACKNOWLEDGMENT

The authors thank Ruby N. Stubbs-Stamps, Shari L. Berry, Michael Wold, Stephanie E. Pritchett, and Shanti M. Mathew forassistance in preparation of the manuscript. A complete list of the DIGinvestigators and institutional affiliations has been publishedpreviously.6

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    • Cited by (0)

    Presented in part at the 47th Annual Scientific Sessions of the American College of Cardiology, Atlanta, GA, March 31, 1998.

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    Copyright © 2000 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.