title: Influence of left ventricular remodeling on atrial fibrillation recurrence and cardiovascular hospitalizations in patients undergoing rhythm-control therapy.
abstract: BACKGROUND
  Atrial fibrillation (AF) patients with left ventricular hypertrophy (LVH) and diastolic dysfunction may derive benefit from being in sinus rhythm but no data are available to support this strategy in them. We sought to investigate effect of left ventricular remodeling on cardiovascular outcomes in AF patients undergoing rhythm control strategy.
  
  
  METHODS
  We identified 1088 patients with echocardiographic data on left ventricular mass (LVM) enrolled in the AFFIRM trial. Using the American Society of Echocardiography (ASE) criteria, patients were divided into 4 categories: 1) normal geometry, 2) concentric remodeling, 3) eccentric hypertrophy, and 4) concentric hypertrophy. The primary endpoint was AF recurrence and the secondary endpoint was cardiovascular hospitalization (CVH).
  
  
  RESULTS
  In rhythm control arm, median time to recurrence in patients with concentric LVH was 13.3 months (95% CI 8.2-24.5) vs. 28.3 months (95% CI 20.2-48.6) in patients without LVH. Concentric left ventricular hypertrophy (LVH) was independently predictive of AF recurrence (HR 1.49, 95% CI 1.10-2.01, p=0.01) in rhythm control arm, but not in overall population or rate control arm. Both concentric and eccentric LVH were independently predictive of cardiovascular hospitalization (CVH) in the overall population, with respective HRs of 1.36 (1.04-1.78, p=0.03) and 1.38 (1.02-1.85, p=0.04).
  
  
  CONCLUSIONS
  Concentric LVH is predictive of AF recurrences when a predominantly pharmacologic rhythm-control strategy is employed. Different patterns of LVH seem to be important determinants of outcomes (AF recurrence and CVH). These findings may have important clinical implications for the management of patients with AF and LVH. Further studies are warranted to confirm our findings.
authors.affiliation: Staten Island University Hospital, Staten Island, NY, United States.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Shah
authors.affiliation: Detroit Medical Center, Detroit, MI, United States.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, United States; Jackson Memorial Hospital, Miami, FL, United States.
authors.forename: Peeyush M
authors.initials: PM
authors.lastname: Grover
authors.affiliation: Staten Island University Hospital, Staten Island, NY, United States.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: Washington Hospital Center, Washington, DC, United States.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: Drexel University School of Public Health, Philadelphia, PA, United States.
authors.forename: Kathan
authors.initials: K
authors.lastname: Mehta
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, United States; Jackson Memorial Hospital, Miami, FL, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoosien
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, United States; Jackson Memorial Hospital, Miami, FL, United States.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, United States; Jackson Memorial Hospital, Miami, FL, United States.
authors.forename: Ghanshyambhai T
authors.initials: GT
authors.lastname: Savani
authors.affiliation: University of Arkansas, Little Rock, AR, United States.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Cedar Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Ankit
authors.initials: A
authors.lastname: Rathod
authors.affiliation: Detroit Medical Center, Detroit, MI, United States.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: Detroit Medical Center, Detroit, MI, United States.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: Detroit Medical Center, Detroit, MI, United States.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Staten Island University Hospital, Staten Island, NY, United States.
authors.forename: Charles
authors.initials: C
authors.lastname: Schwartz
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, United States; Jackson Memorial Hospital, Miami, FL, United States.
authors.forename: Martin
authors.initials: M
authors.lastname: Blisker
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, United States; Jackson Memorial Hospital, Miami, FL, United States.
authors.forename: James O
authors.initials: JO
authors.lastname: Coffey
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, United States; Jackson Memorial Hospital, Miami, FL, United States.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Mitrani
authors.affiliation: The Mount Sinai Medical Center, NY, United States.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, United States. Electronic address: j.vilesgonzalez@med.miami.edu.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Viles-Gonzalez
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000150:complications / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D020257:Ventricular Remodeling
keywords: Atrial fibrillation; Hospitalization; Left ventricular hypertrophy; Rhythm control