title: Association between clinical outcome and antiarrhythmic treatment in heart failure patients who have atrial fibrillation upon admission to the hospital.
abstract: BACKGROUND
  Atrial fibrillation (AF) and heart failure (HF) are associated with significant mortality and morbidity. We sometimes encounter patients who have AF upon admission to the hospital, but it spontaneously converts to sinus rhythm within several days (i.e. converter).
  
  
  OBJECTIVE
  We examined the association between the outcome and types of strategy for AF treatment in converters.
  
  
  METHODS
  From January 2000 to December 2005, we identified 95 converters (age 69 ± 12 years) presenting with worsening HF and AF upon admission, in which sinus rhythm was restored within 7 days without either electrical or pharmacological cardioversion. The patients were classified into three groups according to the antiarrhythmic drug (AAD) therapy used: class I AAD, class III AAD, and rate-control drug. The patients were followed for 36 ± 23 months.
  
  
  RESULTS
  The left ventricular ejection fraction (LVEF) significantly improved with conversion to sinus rhythm (38 ± 14% vs. 47 ± 13%, p<0.05). Those receiving class I AAD had a trend toward a well-preserved LVEF (50 ± 13%, n=35) as compared to those receiving class III AAD (43 ± 12%, n=24) or rate-control drug (47 ± 14%, n=36). In the patients receiving class I AAD, the rate of all-cause death increased 1.9-fold (p=0.009) compared to those receiving class III AAD, and 1.7-fold (p=0.010) compared to those taking rate-control drug. A hospitalization for HF was observed in 49 (52%) patients, however there was no significant difference in the rate of hospitalization among the three groups (p=0.890). Those receiving rate-control drugs had a 50% lower rate of the development of persistent AF than those taking class III AAD (p=0.019).
  
  
  CONCLUSIONS
  A rate-control strategy should be the primary approach for converters to reduce mortality and development of persistent AF.
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan. enwatan@fujita-hu.ac.jp
authors.forename: Eiichi
authors.initials: E
authors.lastname: Watanabe
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Arakawa
authors.forename: Kentarou
authors.initials: K
authors.lastname: Okuda
authors.forename: Mayumi
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Tomohide
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Hiroto
authors.initials: H
authors.lastname: Harigaya
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sobue
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ozaki
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D011379:Prognosis; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents