Outcome of pharmacological rhythm control for new-onset persistent atrial fibrillation in patients with systolic heart failure: a comparison with patients with normal left ventricular function.
OBJECTIVE
To compare outcome of a serial cardioversion strategy in atrial fibrillation (AF) patients with and without systolic heart failure (HF).


RESULTS
In patients with new-onset persistent AF and systolic HF [left ventricular ejection fraction (LVEF) <0.40] outcome of a serial electrical cardioversion (ECV) and serial antiarrhythmic drug strategy was compared with a control group of patients without HF. Follow-up was 18 months. Sixty-four consecutive patients with systolic HF (mean age 64 +/- 12 years, 50% coronary artery disease, LVEF 0.30 +/- 0.07) were enrolled and compared with 48 consecutive patients without HF (mean age 66 +/- 8 years, all LVEF >0.50, 40% lone AF). Success of ECV and occurrence of subacute and late recurrences in patients with and without HF were comparable. After the first relapse, AF was accepted in significantly more HF patients (23 vs. 4%, P < 0.01). Significantly less HF patients underwent serial ECV and antiarrhythmic drug approach (42 vs. 71%, respectively, P < 0.001). At the end of follow-up more HF patients were in permanent AF (45 vs. 29%, P = 0.03).


CONCLUSIONS
Recurrence pattern after ECV is comparable between patients with and without systolic HF, but outcome of a serial cardioversion strategy is worse in HF patients, possibly related to a less stringent use of this approach.
Hemels
Martin E W
ME
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Wiesfeld
Ans C P
AC
Van Veldhuisen
Dirk J
DJ
Van den Berg
Maarten P
MP
Van Gelder
Isabelle C
IC
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D002303:Cardiac Output, Low / Q000209:etiology / Q000517:prevention & control*; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000517:prevention & control*
D000889:Anti-Arrhythmia Agents