Maintenance of Sinus Rhythm and Survival in Patients With Heart Failure and Atrial Fibrillation Academic Article uri icon

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abstract

  • 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 < or =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.

authors

  • Talajic, Mario
  • Khairy, Paul
  • Levesque, Sylvie
  • Connolly, Stuart
  • Dorian, Paul
  • Dubuc, Marc
  • Guerra, Peter G
  • Hohnloser, Stefan H
  • Lee, Kerry L
  • Macle, Laurent
  • Nattel, Stanley
  • Pedersen, Ole D
  • Stevenson, Lynne Warner
  • Thibault, Bernard
  • Waldo, Albert L
  • Wyse, D George
  • Roy, Denis

publication date

  • April 2010