Arrhythmia Burden and Clinical Responses Under Continuous Monitoring in Heart Failure: Observations From the ALLEVIATE-HF Trial

Background

Heart failure is a chronic condition in which the heart cannot pump blood as effectively as the body needs. Many patients with heart failure also develop arrhythmias, or abnormal heart rhythms, which can range from atrial fibrillation to dangerous ventricular rhythms and slow heart rates. These rhythm problems may worsen symptoms, trigger hospitalizations, and sometimes lead to sudden clinical deterioration. However, in ambulatory patients with symptomatic heart failure who do not already have a cardiac implantable electronic device, the true burden of arrhythmias has not been well defined.

A related question is whether managing congestion remotely using device-guided strategies can change how often arrhythmias occur. Congestion refers to fluid buildup, often causing swelling, weight gain, and shortness of breath. The ALLEVIATE-HF trial was designed to examine congestion management using an insertable cardiac monitor, or ICM, a small device placed under the skin that continuously records heart rhythm. This report describes the arrhythmia findings from that trial and how they related to treatment decisions and clinical outcomes.