In patients with chronic atrial fibrillation and left ventricular systolic dysfunction, restoration of sinus rhythm confers substantial benefit.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 0231335 Publication Model: Print Cited Medium: Print ISSN: 0012-3692 (Print) Linking ISSN: 00123692 NLM ISO Abbreviation: Chest Subsets: MEDLINE
    • Publication Information:
      Publication: 2016- : New York : Elsevier
      Original Publication: Chicago : American College of Chest Physicians
    • Subject Terms:
      Electric Countershock*; Atrial Fibrillation/*therapy ; Ventricular Dysfunction, Left/*complications; Adult ; Aged ; Anti-Arrhythmia Agents/therapeutic use ; Atrial Fibrillation/complications ; Atrial Fibrillation/physiopathology ; Case-Control Studies ; Chronic Disease ; Echocardiography ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Systole ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/physiopathology
    • Abstract:
      Study Objectives: To evaluate the benefit of sinus rhythm (SR) restoration in patients with chronic controlled atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD).
      Design: Prospective case-control study on the short-term outcome (6 to 9 months) of clinical and echocardiographic variables following attempted cardioversion.
      Setting: Outpatient clinic of a university hospital.
      Patients: Fifteen men and 5 women, ranging in age from 40 to 76 years, who had chronic controlled (mean [+/- SD] ventricular rate, 82 +/- 10 beats/min) AF and left ventricular fractional shortening (LVFS) of < 28% at baseline. Control was provided by retrospective paired echocardiographic examinations of six AF patients, plus the study cases with potentially unsuccessful cardioversion or early recurrence of AF.
      Interventions: Attempt to restore SR with amiodarone or electrical countershock.
      Measurements and Results: Conversion was attained in 17 patients, but AF recurred early in 4 patients, 3 of whom had proven ischemic LVSD. In the 13 patients with sustained SR, LVFS increased from 20 +/- 4% to 31 +/- 6% (p < 0.0001). In contrast, no changes were detected in the control group (n = 13). This improvement was paralleled by decreases in left ventricular (LV) end-diastolic dimension (from 55 +/- 7 to 51 +/- 6 mm; p = 0.014), LV mass (from 181 +/- 28 to 159 +/- 37 g; p = 0.015), and left atrial diameter (from 45 +/- 9 mm to 42 +/- 7; p = 0.003). A marked decrease in heart rate (from 82 +/- 9 to 64 +/- 5 beats/min; p < 0.0001) and a reduction in New York Heart Association functional class (from 2.3 +/- 0.9 to 1.2 +/- 0.4; p = 0.0007) also were observed in patients with sustained SR but not among subjects in the control group.
      Conclusions: Even when adequate control of the ventricular rate has been achieved, the LV function of patients with chronic AF greatly improves after restoration and maintenance of SR.
    • Accession Number:
      0 (Anti-Arrhythmia Agents)
    • Publication Date:
      Date Created: 20010714 Date Completed: 20010809 Latest Revision: 20190514
    • Publication Date:
      20231215
    • Accession Number:
      10.1378/chest.120.1.132
    • Accession Number:
      11451828