Vol 13, No 6 (2006): Folia Cardiologica
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Published online: 2006-07-10

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Atrial fibrillation as a prognostic factor in patients with systolic heart failure

Rafał Grzybczak, Jadwiga Nessler, Wiesława Piwowarska
Folia Cardiol 2006;13(6):503-510.


Background: Atrial fibrillation (AF) decreases left ventricular stroke volume, impaires the mechanical function of heart valves, and disturbes neurohumoral activity of the miocardium. This study evaluated the influence of AF on clinical presentation and long-term follow-up of the patients with systolic heart failure.
Methods: A retrospective analysis of the data on clinical presentation of 152 patients (38 women and 114 men) with systolic heart failure (EF < 40%) was performed. The following parameters were compared between patients with and without AF: heart rate and presence of LBBB, several echocardiographic parameters (EF, LVEDV, size of LA, LVEDd, LVESd), oxygen consumption per minute, and frequency of end-point’s (death, stroke, rehospitalization, CABG) during mean 936-day follow-up.
Results: The 53 (35%) AF patients in comparison with 99 non-AF were characterized by: lower exercise performance (VO2max = 10.9 vs. 17.2 ml/kg/min), greater diameter of the left atrium (49.9 vs. 45.9 mm) and decreased end-diastolic volume (LVEDV = 159.5 vs. 183.7 ml), less frequent occurrence of LBBB (7.5% vs. 13.0%), higher overall mortality (28.3% vs. 17.1%), and more frequent rehospitalizations (15% vs. 8%). In patients with persistent AF (40%) with HR < 75/min the mortality was 29% and was statistically significantly lower than in patients with HR > 75/min in whom it was 54%.
Conclusions: Atrial fibrillation in patients with systolic heart failure is a disadvantageous, but not independent risk factor. In patients with persistent atrial fibrillation the control of heart rate < 75/min was associated with significant decrease in mortality.

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