Treatment Failure With Rhythm and Rate Control Strategies in Patients With Atrial Fibrillation and Congestive Heart Failure: An AF-CHF Substudy

Journal of Cardiovascular Electrophysiology
Katia DyrdaPaul Khairy

Abstract

Rate and rhythm control strategies for atrial fibrillation (AF) are not always effective or well tolerated in patients with congestive heart failure (CHF). We assessed reasons for treatment failure, associated characteristics, and effects on survival. A total of 1,376 patients enrolled in the AF-CHF trial were followed for 37  ±  19 months, 206 (15.0%) of whom failed initial therapy leading to crossover. Rhythm control was abandoned more frequently than rate control (21.0% vs. 9.1%, P < 0.0001). Crossovers from rhythm to rate control were driven by inefficacy, whereas worsening heart failure was the most common reason to crossover from rate to rhythm control. In multivariate analyses, failure of rhythm control was associated with female sex, higher serum creatinine, functional class III or IV symptoms, lack of digoxin, and oral anticoagulation. Factors independently associated with failure of rate control were paroxysmal (vs. persistent) AF, statin therapy, and presence of an implantable cardioverter-defibrillator. Crossovers were not associated with cardiovascular mortality (hazard ratio [HR] 1.11 from rhythm to rate control; 95% confidence interval [95% CI, 0.73-1.73]; P = 0.6069; HR 1.29 from rate to rhythm control; 95% CI, ...Continue Reading

References

Dec 1, 1993·JAMA : the Journal of the American Medical Association·R R MakkarM H Lehmann
May 9, 2000·Clinical Pharmacology and Therapeutics·R E BentonR L Woosley
Dec 6, 2002·The New England Journal of Medicine·D G WyseUNKNOWN Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators
Jun 21, 2008·The New England Journal of Medicine·Denis RoyUNKNOWN Atrial Fibrillation and Congestive Heart Failure Investigators
Apr 24, 2010·Journal of the American College of Cardiology·Mario TalajicUNKNOWN AF-CHF Investigators
Oct 4, 2012·International Journal of Cardiology·Linda KoutbiPaul Khairy
Dec 26, 2012·Journal of the American College of Cardiology·Irina Suman-HordunaUNKNOWN AF-CHF Trial Investigators
May 22, 2013·Heart Failure Reviews·Rafik TadrosDenis Roy

❮ Previous
Next ❯

Related Concepts

Related Feeds

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Atrial Filbrillation

Atrial fibrillation refers to the abnormal heart rhythm characterized by rapid and irregular beating of the atria. Here is the latest research.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.