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[Effect of cardioversion of atrial fibrillation on left ventricular function in dilated cardiomyopathy. A multicenter
A Sacrez1, J R Kieny, J B Bouhour
1Service de cardiologie, hôpital de Hautepierre, Strasbourg.
Insights
Restoring sinus rhythm in patients with idiopathic dilated cardiomyopathy and atrial fibrillation significantly improves left ventricular function. Cardioversion is a key factor in normalizing heart function in these patients.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
Background:
- Idiopathic dilated cardiomyopathy (IDCM) often involves left ventricular dysfunction and arrhythmias.
- Atrial fibrillation (AF) is common in IDCM and impacts cardiac function.
- Left bundle branch block (LBBB) and ventricular arrhythmias are also prevalent in IDCM.
Purpose of the Study:
- To evaluate the medium-term echocardiographic evolution of left ventricular (LV) function in IDCM patients.
- To assess the specific impact of cardioversion of atrial fibrillation on LV function.
Main Methods:
- Prospective follow-up of 73 IDCM patients for an average of 22 months.
- Echocardiographic assessment of LV function parameters.
- Analysis of the effects of cardioversion from AF to sinus rhythm.
Main Results:
- LV function improved over follow-up, with normalization in 12% of cases.
- Cardioversion of AF to sinus rhythm was the sole predictor of LV function normalization (p<0.02).
- Patients with successful cardioversion showed greater LV function improvement (50% normalization) compared to those in sinus rhythm or chronic AF (8% normalization).
Conclusions:
- Restoring sinus rhythm is crucial for improving LV function in IDCM patients with AF.
- Cardioversion represents a valuable therapeutic strategy for enhancing cardiac function in this population.
- Further research into optimizing rhythm control strategies for IDCM is warranted.
Abstract:
A group of 73 patients with idiopathic dilated cardiomyopathy were followed up for an average of 22 +/- 7 months to assess the medium term evolution of echocardiographic parameters of left ventricular function and, in particular, the consequences of cardioversion of atrial fibrillation. Seventy nine per cent of patients presented with cardiac failure. Left bundle branch block was observed in 20% and ventricular arrhythmias were frequent in 31%, complex in 62% with episodes of non-sustained ventricular tachycardia in 10% of cases. Left ventricular dilatation was greater in patients with complete left bundle branch block (p less than 0.003). Atrial fibrillation was present in 14 patients (19%) who were generally older than the rest of the study population (p less than 0.02) and was associated with less severe left ventricular dysfunction (p less than 0.01). Return to sinus rhythm was obtained in 9 patients. Echocardiographic data was obtained in 64 patients after an average of 6.2 +/- 1.7 months. Left ventricular function improved during the follow-up period and returned to normal in 12% of cases. Reduction of atrial fibrillation to sinus rhythm was the only predictive factor of normalisation of left ventricular function (p less than 0.02). The changes in left ventricular end diastolic dimension and fractional shortening was less marked in the group of 56 patients in sinus rhythm or chronic atrial fibrillation (normalisation of left ventricular function in 8% of cases) than in the group of 8 patients in which atrial fibrillation was converted to sinus rhythm (normalisation of left ventricular function in 50% of cases).(ABSTRACT TRUNCATED AT 250 WORDS)