Influence of left ventricular remodeling on atrial fibrillation recurrence and cardiovascular hospitalizations in patients undergoing rhythm-control therapy.
Publication/Presentation Date
6-15-2014
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).
CONCLUSION: 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.
Volume
174
Issue
2
First Page
288
Last Page
292
ISSN
1874-1754
Published In/Presented At
Shah, N., Badheka, A. O., Grover, P. M., Patel, N. J., Chothani, A., Mehta, K., Hoosien, M., Singh, V., Savani, G. T., Deshmukh, A., Rathod, A., Patel, N., Panaich, S. S., Arora, S., Schwartz, C., Blisker, M., Coffey, J. O., Mitrani, R. D., Fuster, V., & Viles-Gonzalez, J. F. (2014). Influence of left ventricular remodeling on atrial fibrillation recurrence and cardiovascular hospitalizations in patients undergoing rhythm-control therapy. International journal of cardiology, 174(2), 288–292. https://doi.org/10.1016/j.ijcard.2014.04.011
Disciplines
Medicine and Health Sciences
PubMedID
24794553
Department(s)
Fellows and Residents
Document Type
Article