Paroxysmal atrial fibrillation coincident with cardiac decompensation is a predictor of poor prognosis in chronic heart failure.
BACKGROUND
The prognostic significance of atrial fibrillation (AF) in chronic heart failure (CHF) remains poorly understood.


RESULTS
Death and rehospitalizaion for CHF exacerbation for 427 consecutive patients hospitalized from 1996 to 2002 were retrospectively analyzed in relation to cardiac rhythm: sinus rhythm (SR; n=239) or AF (n=188). The AF group was classified according to an Intervention (n=57) or Non-Intervention (n=131) group for defibrillating AF. During the follow-up of 34+/-23 months, there was no significant difference of mortality or morbidity between the SR and AF groups, or between the Intervention and Non-Intervention groups, respectively. However, the Non-Intervention group consisted of 28 patients with paroxysmal AF (PAF), which spontaneously converted to SR during hospitalization, and 103 with chronic AF (CAF). The rehospitalization for CHF exacerbation was significantly higher in PAF than that in CAF and SR (p=0.00005 and 0.002, respectively). Multivariate Cox analysis demonstrated that, PAF, but not CAF, was a predictor of readmission (relative risk 2.30, p=0.004, 95% confidence interval 1.30 to 4.05).


CONCLUSIONS
The present data implied that PAF coincident with cardiac decompensation could be a new predictor of prognosis for CHF. The management strategies of AF in CHF should be discussed according to the phenotype of AF.
Koitabashi
Toshimi
T
Department of Internal Medicine and Cardiology, Kitasato University School of Medicine, Sagamihara, Japan. toshimi@pk9.so-net.ne.jp
Inomata
Takayuki
T
Niwano
Shinichi
S
Nishii
Mototsugu
M
Takeuchi
Ichiro
I
Nakano
Hironari
H
Shinagawa
Hisahito
H
Takehana
Hitoshi
H
Izumi
Tohru
T
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012849:Sinoatrial Node