Maintenance of Sinus Rhythm and Survival in Patients With Heart Failure and Atrial Fibrillation

• Published in: Journal of the American College of Cardiology Vol. 55; no. 17; pp. 1796 - 1802
• Main Authors: Talajic, Mario, MD, Khairy, Paul, MD, PhD, Levesque, Sylvie, MSc, Connolly, Stuart J., MD, Dorian, Paul, MD, Dubuc, Marc, MD, Guerra, Peter G., MD, Hohnloser, Stefan H., MD, Lee, Kerry L., PhD, Macle, Laurent, MD, Nattel, Stanley, MD, Pedersen, Ole D., MD, Stevenson, Lynne Warner, MD, Thibault, Bernard, MD, Waldo, Albert L., MD, Wyse, D. George, MD, PhD, Roy, Denis, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 27.04.2010; Elsevier; Elsevier Limited
• Subjects: Aged; antiarrhythmia agents; Anticoagulants; atrial fibrillation; Atrial Fibrillation - mortality; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular; congestive heart failure; Drug therapy; Electrocardiography; Female; Heart; Heart attacks; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Rate - physiology; Humans; Internal Medicine; Male; Medical sciences; Mortality; CHF; heart failure; AF; CI; ECG; HR; atrial fibrillation; electrocardiogram; anticoagulants; hazard ratio; congestive heart failure; confidence interval; antiarrhythmia agents; HF; Human; Heart failure; Prognosis; Arrhythmia; Atrial fibrillation; Cardiovascular disease; Patient; Maintenance; Survival; Excitability disorder; Heart disease; Circulatory system; Cardiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2010.01.023

Objectives The goal of this study was to evaluate the relationship between the presence of sinus rhythm and outcomes in patients with a history of congestive heart failure (CHF) and atrial fibrillation (AF). Background The value of sinus rhythm maintenance in patients with AF and heart failure (HF) is uncertain. Methods A total of 1,376 patients with AF, ejection fraction ≤35%, and heart failure symptoms were randomized to a rhythm- or rate-control strategy. Detailed efficacy analyses were used to evaluate the independent effects of treatment strategy and the presence of sinus rhythm on cardiovascular outcomes. Results Overall, 445 (32%) patients died and 402 (29%) experienced worsening HF. The rhythm-control strategy was not predictive of cardiovascular mortality (hazard ratio [HR]: 0.90, 95% confidence interval [CI]: 0.70 to 1.16; p = 0.41), all-cause death (HR: 0.86, 95% CI: 0.69 to 1.08; p = 0.19), or worsening HF (HR: 0.86, 95% CI: 0.68 to 1.10; p = 0.23). In analyses devised to isolate the effect of underlying rhythm, sinus rhythm was not associated with cardiovascular mortality [HR: 1.22, 95% CI: 0.80 to 1.87; p = 0.35), total mortality [HR: 1.11, 95% CI: 0.78 to 1.58; p = 0.57), or worsening HF [HR: 0.62, 95% CI: 0.37 to 1.02; p = 0.059). Conclusions A rhythm-control strategy or the presence of sinus rhythm are not associated with better outcomes in patients with AF and CHF.