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Treatment Failure With Rhythm and Rate Control Strategies in Patients With Atrial Fibrillation and Congestive Heart
Katia Dyrda1, Denis Roy1, Hugues Leduc2
1Electrophysiology Service, Montreal Heart Institute, Université de Montréal.
Journal of Cardiovascular Electrophysiology
|September 3, 2015
Summary
Rhythm control is abandoned more often than rate control in patients with atrial fibrillation (AF) and congestive heart failure (CHF). However, switching strategies between rate and rhythm control does not affect patient survival.
Area of Science:
- Cardiology
- Heart Failure Management
- Atrial Fibrillation Treatment
Background:
- Atrial fibrillation (AF) and congestive heart failure (CHF) often coexist.
- Current rate and rhythm control strategies for AF may be ineffective or poorly tolerated in CHF patients.
- Understanding treatment failures and their impact on survival is crucial.
Purpose of the Study:
- To assess reasons for treatment failure in AF-CHF patients.
- To identify patient characteristics associated with treatment failure.
- To evaluate the effects of switching rate and rhythm control strategies on survival.
Main Methods:
- Analysis of 1,376 patients from the AF-CHF trial.
- Follow-up duration of 37 ± 19 months.
- Multivariate analyses to identify factors associated with treatment failure and survival.
Main Results:
- 15.0% of patients (206) failed initial therapy, leading to strategy crossover.
- Rhythm control was abandoned more frequently (21.0%) than rate control (9.1%).
- Reasons for failure included inefficacy (rhythm control) and worsening heart failure (rate control).
- Crossovers were not associated with cardiovascular or all-cause mortality.
Conclusions:
- Rhythm control is abandoned more frequently than rate control in AF-CHF patients.
- Treatment strategy changes in AF-CHF do not impact survival.
- In-efficacy and worsening heart failure are key reasons for abandoning rhythm and rate control, respectively.
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