Incidence of Cardiac Arrhythmias Identified by Insertable Cardiac Monitors in Patients With Symptomatic Heart Failure

Rami Kahwash; Javed Butler; Muhammad Shahzeb Khan; Prasad Chalasani; Barry Bertolet; Laura Gravelin; Cameron Lambert; Shantanu Sarkar; Brian Van Dorn; Aimee Laechelt; Jennifer Wehking; Nirav Patel; Bart Gerritse; Verla Laager; Michael R Zile

doi:10.1016/j.jchf.2025.102527

Incidence of Cardiac Arrhythmias Identified by Insertable Cardiac Monitors in Patients With Symptomatic Heart Failure

JACC Heart Fail. 2025 Jul 1;13(8):102527. doi: 10.1016/j.jchf.2025.102527. Online ahead of print.

Authors

Affiliations

¹ The Ohio State University, Columbus, Ohio, USA. Electronic address: rami.kahwash@osumc.edu.
² Baylor Scott and White Research Institute, Dallas, Texas, USA; University of Mississippi Medical Center, Jackson, Mississippi, USA.
³ Baylor Scott and White Research Institute, Dallas, Texas, USA; Department of Medicine, Baylor College of Medicine, Temple, Texas, USA; The Heart Hospital, Plano, Texas, USA.
⁴ Florida Heart Center, Fort Pierce, Florida, USA.
⁵ Cardiology Associates Research LLC, North Mississippi Medical Center, Tupelo, Mississippi, USA.
⁶ Mount Carmel Health System, Columbus, Ohio, USA.
⁷ Cone Health, Greensboro, North Carolina, USA.
⁸ Medtronic, Mounds View, Minnesota, USA.
⁹ Medtronic Bakken Research Center, Maastricht, the Netherlands.
¹⁰ Medical University of South Carolina, Charleston, South Carolina, USA; Ralph H. Johnson Department of Veterans Affairs Health Care System, Charleston, South Carolina, USA.

PMID: 40602175
DOI: 10.1016/j.jchf.2025.102527

Abstract

Background: Cardiac bradyarrhythmias and tachyarrhythmias in chronic heart failure (CHF) patients are associated with increased morbidity and mortality. Insertable cardiac monitors provide a continuous, ambulatory, accurate monitoring strategy for patients with CHF who are not candidates for cardiac implantable electronic devices.

Objectives: This study aims to assess the occurrence of cardiac arrhythmias (CAs) in patients with CHF across the ejection fraction (EF) spectrum and not indicated for cardiac implantable electronic devices.

Methods: Patients with recent heart failure events enrolled in LINQ-HF (Reveal LINQ Heart Failure) and Phase 1 ALLEVIATE-HF (Algorithm Using LINQ Sensors for Evaluation and Treatment of Heart Failure) studies were implanted with an insertable cardiac monitor. All CAs were adjudicated first using an artificial intelligence model, then manually verified, and grouped into 3 categories: atrial fibrillation (AF), ventricular tachycardia (VT) or fibrillation (VF), and bradycardia/pauses.

Results: In total, 163 patients (mean age 67.2 ± 11.2 years, 62.6% male, 49.1% EF ≥50%, 83.4% Class III, 55.2% history of AF) were followed for 17.2 ± 9.8 months. Occurrence of AF was 59.7% at 2 years, 53.1% in heart failure with reduced ejection fraction (HFrEF) <50%, and 64.6% in heart failure with preserved ejection fraction (HFpEF) ≥50%. Incidence of AF in patients without prior AF was 23.8%, 23.9% in HFrEF, and 27.6% in HFpEF. Incidence of bradycardia or pause was 37.2% overall, (37.5% in HFrEF and 39.8% in HFpEF; 30.3% during daytime vs 19.4% during nighttime). Incidence of VT/VF was 14.3% overall, 19.8% in HFrEF, and 10.4%, in HFpEF.

Conclusions: In CHF patients undergoing ambulatory, continuous, accurate arrhythmia monitoring, the incidence of AF and bradycardia/pause events was high and similar in HFpEF vs HFrEF patients. VT/VF was lower in HFpEF than HFrEF, but clinically important.

Keywords: arrhythmia detection; artificial intelligence; heart failure; insertable cardiac monitor.