MedStar Authors catalog › Details for: Outcomes in atrial fibrillation patients with and without left ventricular hypertrophy when treated with a lenient rate-control or rhythm-control strategy.
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Outcomes in atrial fibrillation patients with and without left ventricular hypertrophy when treated with a lenient rate-control or rhythm-control strategy.

by Chothani, Ankit.
Citation: American Journal of Cardiology. 113(7):1159-65, 2014 Apr 1..Journal: The American journal of cardiology.ISSN: 0002-9149.Full author list: Badheka AO; Shah N; Grover PM; Patel NJ; Chothani A; Mehta K; Singh V; Deshmukh A; Savani GT; Rathod A; Panaich SS; Patel N; Arora S; Bhalara V; Coffey JO; Mitrani RD; Halperin JL; Viles-Gonzalez JF.UI/PMID: 24507168.Subject(s): Aged | *Anti-Arrhythmia Agents/tu [Therapeutic Use] | *Atrial Fibrillation/dt [Drug Therapy] | Atrial Fibrillation/et [Etiology] | Atrial Fibrillation/mo [Mortality] | Cause of Death/td [Trends] | Echocardiography | Female | Follow-Up Studies | *Heart Rate/ph [Physiology] | Humans | Hypertrophy, Left Ventricular/co [Complications] | *Hypertrophy, Left Ventricular/dt [Drug Therapy] | Hypertrophy, Left Ventricular/us [Ultrasonography] | Male | Prognosis | Survival Rate/td [Trends] | United States/ep [Epidemiology]Institution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/General Internal MedicineActivity type: Journal Article.Medline article type(s): Journal Article | Multicenter Study | Randomized Controlled TrialOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: Am J Cardiol. 113(7):1159-65, 2014 Apr 1.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: Although left ventricular (LV) hypertrophy has been proposed as a factor predisposing to atrial fibrillation (AF), its relevance to prognosis and selection of therapeutic strategies is unclear. We identified 2,105 patients with echocardiographic data on LV mass enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial. LV hypertrophy was defined as increased LV mass, stratified by American Society of Echocardiography criteria. The primary end point was all-cause mortality, secondary end point was as per AFFIRM trial definition, and tertiary end point was cardiovascular hospitalizations. We compared "strict" versus "lenient" rate control in patients with increased LV mass, and studied association of heart failure (HF) with preserved and decreased systolic function in patients with increased LV mass. Over 6 years, 332 deaths (15.7%) were reported. Adjusted hazard ratio (HR) of severely increased LV mass for all-cause mortality was 1.34 (95% confidence interval [CI] 1.01 to 1.79, p=0.045) for the overall population and 1.61 (95% CI 1.09 to 2.37, p=0.016) for the rhythm-control arm. Increased LV mass was a predictor of cardiovascular hospitalizations in the lenient rate-control group (HR 1.72, 95% CI 1.05 to 2.82, p=0.03) but not in the strict rate-control group. Severely increased LV mass was predictive of cardiovascular hospitalizations in patients with HF with preserved (HR 1.8, 95% CI 1.0 to 3.2, p=0.03) and decreased LV systolic function (HR 2.4, 95% CI 1.1 to 5.2, p=0.02). Thus, LV hypertrophy is a significant independent predictor of mortality in patients with AF, especially those managed with rhythm control. In patients with LV hypertrophy, strict rate control may be associated with better outcomes than lenient rate control. LV hypertrophy portends higher cardiovascular morbidity in patients with AF and HF. Copyright 2014 Elsevier Inc. All rights reserved.

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