title: Cardiac remodeling with rhythm versus rate control strategies for atrial fibrillation in patients with heart failure: insights from the AF-CHF echocardiographic sub-study.
abstract: BACKGROUND
  In patients with heart failure and atrial fibrillation, the AF-CHF (Atrial Fibrillation and Congestive Heart Failure) trial did not demonstrate the superiority of rhythm control (RhyC) over a rate control (RaC) strategy on cardiovascular mortality. Nevertheless, deleterious hemodynamic effects of atrial fibrillation can lead to further decrease in left ventricular (LV) function and progression of symptoms. This echocardiographic sub-study was designed to compare the effects of the two treatment strategies on LV ejection fraction (LVEF), chamber volumes and dimensions, valvular regurgitation and functional status.
  
  
  RESULTS
  A total of 59 patients (29 RhyC, 30 RaC) aged 67±8 years (14% women), enrolled in the AF-CHF trial at the Montreal Heart Institute underwent standardized echocardiograms at baseline and at 12 months. Mean LVEF at baseline was severely depressed (RhyC: 27.0±4.9% and RaC: 27.6±7.4%, p=0.73), and improved to a similar degree in both groups (RhyC: +8.0±10.4% and RaC: +4.5±10.6, both p<0.05; p=0.19 for RhyC versus RaC). Other echocardiographic parameters, such as LV end-systolic volume index and degree of mitral and tricuspid regurgitation, remained unchanged. New York Heart Association functional class and distance walked in 6 min improved significantly in both groups (RhyC: +48.9±78.7 m and RaC: +47.2±96.7 m, both p≤0.01), with no difference between RhyC and RaC strategies.
  
  
  CONCLUSIONS
  Improvements in LVEF and functional status are observed after 12 months in patients with heart failure and atrial fibrillation, regardless of whether rate or rhythm control strategies are used.
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Valérie
authors.initials: V
authors.lastname: Henrard
authors.forename: Anique
authors.initials: A
authors.lastname: Ducharme
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Alejandro
authors.initials: A
authors.lastname: Gisbert
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.forename: Sylvie
authors.initials: S
authors.lastname: Levesque
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Bernard
authors.initials: B
authors.lastname: Thibault
authors.forename: Normand
authors.initials: N
authors.lastname: Racine
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.forename: Peter G
authors.initials: PG
authors.lastname: Guerra
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D004452:Echocardiography / Q000379:methods; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020257:Ventricular Remodeling / Q000187:drug effects / Q000502:physiology*
chemical_list: D002121:Calcium Channel Blockers