title: Maintenance of sinus rhythm and survival in patients with heart failure and atrial fibrillation.
abstract: OBJECTIVE
  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.affiliation: Research Center, Montreal Heart Institute, 5000 Bélanger Street, Montreal, Quebec, Canada. mario.talajic@icm-mhi.org
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Sylvie
authors.initials: S
authors.lastname: Levesque
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Connolly
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.forename: Marc
authors.initials: M
authors.lastname: Dubuc
authors.forename: Peter G
authors.initials: PG
authors.lastname: Guerra
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Hohnloser
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.forename: Stanley
authors.initials: S
authors.lastname: Nattel
authors.forename: Ole D
authors.initials: OD
authors.lastname: Pedersen
authors.forename: Lynne Warner
authors.initials: LW
authors.lastname: Stevenson
authors.forename: Bernard
authors.initials: B
authors.lastname: Thibault
authors.forename: Albert L
authors.initials: AL
authors.lastname: Waldo
authors.forename: D George
authors.initials: DG
authors.lastname: Wyse
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male