title: Adverse effects of permanent atrial fibrillation on heart failure in patients with preserved left ventricular function and chronic right apical pacing for complete heart block.
abstract: BACKGROUND
  The impact of atrial fibrillation (AF) on heart failure (HF) was evaluated in patients with preserved left ventricular (LV) function and long-term right ventricular (RV) pacing for complete heart block.
  
  
  METHODS
  Clinical, echocardiographic, and laboratory parameters of HF were assessed in 35 patients with established AF who had undergone ablation of the atrioventricular node and pacemaker implantation (Group A) and 31 patients who received dual-chamber pacing for spontaneous complete heart block (Group B).
  
  
  RESULTS
  During a follow-up period of 12.7 ± 7.5 years, New York Heart Association (NYHA) functional class increased from 1.3 ± 0.5 to 2.1 ± 0.6 (p < 0.0001) in Group A, and from 1.3 ± 0.4 to 1.6 ± 0.7 (p < 0.01) in Group B. Left ventricular ejection fraction (LVEF) decreased from 59.7 ± 5.1 to 53.0 ± 8.2 (p < 0.0001) in Group A, but remained stable (58.6 ± 4.2 vs. 56.9 ± 7.0 %, p = 0,21) in Group B. At the end of follow-up, markers of LV function were moderately depressed in Group A compared with those in Group B: NYHA class 2.1 ± 0.6 versus 1.6 ± 0.7, p = 0.001; LVEF 53.0 ± 8.2 versus 56.9 ± 7.0 %, p < 0.05; LV diastolic diameter 53.6 ± 5.8 mm versus 50.7 ± 4.9 mm, p < 0.05; N-terminal pro-brain natriuretic peptide (NT-proBNP) 1116.8 ± 883.9 versus 622.9 ± 1059.4 pg/ml, p < 0.05. Progression of paroxysmal AF to permanent AF during follow-up was common, while new onset of AF was rare. Permanent AF was an independent predictor of declining LVEF >10 %, increasing NYHA class ≥1, and NT-proBNP levels >1,000 pg/ml.
  
  
  CONCLUSIONS
  Permanent AF was associated with adverse effects on LV function and symptoms of HF in patients with long-term RV pacing for complete heart block, and appears to play an important role in the development of HF in this specific patient cohort.
authors.affiliation: Department of Cardiology, University of Bonn, Bonn, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Lampe
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Jörg Otto
authors.initials: JO
authors.lastname: Schwab
authors.forename: Fritz
authors.initials: F
authors.lastname: Mellert
authors.forename: Birgit
authors.initials: B
authors.lastname: Stoffel-Wagner
authors.forename: Andreas
authors.initials: A
authors.lastname: Grigull
authors.forename: Rolf
authors.initials: R
authors.lastname: Fimmers
authors.forename: Bernhard
authors.initials: B
authors.lastname: Maisch
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Thorsten
authors.initials: T
authors.lastname: Lewalter
authors.forename: Alexander
authors.initials: A
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000503:physiopathology / Q000628:therapy*; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left