On Demand: When HF and Arrhythmias Collide: Rethinking Monitoring, Risk and Device Decisions-Webinar Slides

Webinar Slides

Pdf Summary

This MedAxiom webinar, led by John D. Rogers, MD, examined the intersection of heart failure (HF) and arrhythmias and argued for broader use of continuous rhythm monitoring with insertable cardiac monitors (ICMs). The presentation emphasized that short-term or symptom-driven monitoring often misses clinically important arrhythmias, especially in HF patients, many of whom have overlapping symptoms such as dyspnea, fatigue, dizziness, and presyncope.<br /><br />A major focus was the ALLEVIATE-HF trial, a prospective multicenter study of 711 symptomatic NYHA class II–III HF patients across the ejection-fraction spectrum who had recent HF events and no implanted cardiac device. Continuous ICM monitoring showed a high arrhythmia burden: 77% had at least one arrhythmia, 65% had atrial fibrillation (AF), 42% had bradycardia/pause, and 11.5% had ventricular tachycardia/fibrillation (VT/VF). Importantly, 23% of patients without prior AF developed new AF. The findings suggested that arrhythmias are common in both HFrEF and HFpEF, with ventricular arrhythmias more common in reduced EF and bradyarrhythmias more common in HFpEF.<br /><br />The detected arrhythmias often changed management: patients underwent device implantation, ablation, cardioversion, anticoagulation initiation, antiarrhythmic therapy, and left atrial appendage closure. Arrhythmia detection was associated with higher rates of hospitalization and mortality-related events, reinforcing its clinical significance.<br /><br />The talk also noted that sudden cardiac death remains a major issue in HF, yet ICD use is underutilized in eligible patients. Finally, it introduced the ELEVATE-HFpEF trial, which will test whether personalized elevated pacing with conduction system pacing improves outcomes in HFpEF. Overall, the presentation argued that HF patients should be viewed as arrhythmia patients and that long-term monitoring can uncover actionable disease.

Keywords

heart failure

arrhythmias

insertable cardiac monitors

continuous rhythm monitoring

atrial fibrillation

ventricular tachycardia

bradycardia

HFpEF

HFrEF

ALLEVIATE-HF trial