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Published online: 2020-08-11
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Impact of successful restoration of sinus rhythm in patients with atrial fibrillation and acute heart failure: results from the Korean Acute Heart Failure registry

Youngjin Cho, Il-Young Oh, Jin Joo Park, Byung-Hee Oh, Eun-Seok Jeon, Jae-Joong Kim, Kyung-Kuk Hwang, Myeong-Chan Cho, Shung Chull Chae, Sang Hong Baek, Seok-Min Kang, Byung-Su Yoo, Youngkeun Ahn, Dong-Ju Choi
DOI: 10.5603/CJ.a2020.0103
·
Pubmed: 32789837

open access

Ahead of print
Original articles
Published online: 2020-08-11

Abstract

Background: Restoring and maintaining sinus rhythm (SR) in patients with atrial fibrillation (AF) failed to show superior outcomes over rate control strategies in prior randomized trials. However, there is sparse data on their outcomes in patients with acute heart failure (AHF).

Methods: From December 2010 to February 2014, 5,625 patients with AHF from 10 tertiary hospitals were enrolled in the Korean Acute Heart Failure registry, including 1,961 patients whose initial electrocardiogram showed AF. Clinical outcomes of patients who restored sinus rhythm by pharmacological or electrical cardioversion (SR conversion group, n = 212) were compared to those of patients who showed a persistent AF rhythm (AF persistent group, n = 1,662).

Results: All-cause mortality both in-hospital and during the follow-up (median 2.5 years) were significantly lower in the SR conversion group than in the AF persistent group after adjustment for risk factors (adjusted hazard ratio [HR]; 95% confidence interval [CI] = 0.26 [0.08–0.88], p = 0.031 and 0.59 [0.43–0.82], p = 0.002, for mortality in-hospital and during follow-up, respectively). After 1:3 propensity score matching (SR conversion group = 167, AF persistent group = 501), successful restoration of sinus rhythm was associated with lower all-cause mortality (HR [95% CI)] = 0.68 [0.49–0.93], p = 0.015), heart failure rehospitalization (HR [95% CI)] = 0.66 [0.45–0.97], p = 0.032), and composite of death and heart failure rehospitalization (HR [95% CI)] = 0.66 [0.51–0.86], p = 0.002).

Conclusions: Patients with AHF and AF had significantly lower mortality in-hospital and during follow-up if rhythm treatment for AF was successful, underscoring the importance of restoring sinus rhythm in patients with AHF.

Abstract

Background: Restoring and maintaining sinus rhythm (SR) in patients with atrial fibrillation (AF) failed to show superior outcomes over rate control strategies in prior randomized trials. However, there is sparse data on their outcomes in patients with acute heart failure (AHF).

Methods: From December 2010 to February 2014, 5,625 patients with AHF from 10 tertiary hospitals were enrolled in the Korean Acute Heart Failure registry, including 1,961 patients whose initial electrocardiogram showed AF. Clinical outcomes of patients who restored sinus rhythm by pharmacological or electrical cardioversion (SR conversion group, n = 212) were compared to those of patients who showed a persistent AF rhythm (AF persistent group, n = 1,662).

Results: All-cause mortality both in-hospital and during the follow-up (median 2.5 years) were significantly lower in the SR conversion group than in the AF persistent group after adjustment for risk factors (adjusted hazard ratio [HR]; 95% confidence interval [CI] = 0.26 [0.08–0.88], p = 0.031 and 0.59 [0.43–0.82], p = 0.002, for mortality in-hospital and during follow-up, respectively). After 1:3 propensity score matching (SR conversion group = 167, AF persistent group = 501), successful restoration of sinus rhythm was associated with lower all-cause mortality (HR [95% CI)] = 0.68 [0.49–0.93], p = 0.015), heart failure rehospitalization (HR [95% CI)] = 0.66 [0.45–0.97], p = 0.032), and composite of death and heart failure rehospitalization (HR [95% CI)] = 0.66 [0.51–0.86], p = 0.002).

Conclusions: Patients with AHF and AF had significantly lower mortality in-hospital and during follow-up if rhythm treatment for AF was successful, underscoring the importance of restoring sinus rhythm in patients with AHF.

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Keywords

atrial fibrillation, acute heart failure, cardioversion

About this article
Title

Impact of successful restoration of sinus rhythm in patients with atrial fibrillation and acute heart failure: results from the Korean Acute Heart Failure registry

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-08-11

DOI

10.5603/CJ.a2020.0103

Pubmed

32789837

Keywords

atrial fibrillation
acute heart failure
cardioversion

Authors

Youngjin Cho
Il-Young Oh
Jin Joo Park
Byung-Hee Oh
Eun-Seok Jeon
Jae-Joong Kim
Kyung-Kuk Hwang
Myeong-Chan Cho
Shung Chull Chae
Sang Hong Baek
Seok-Min Kang
Byung-Su Yoo
Youngkeun Ahn
Dong-Ju Choi

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