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Prognostic significance of atrial fibrillation in dilated cardiomyopathy
A Takarada1, H Kurogane, T Hayashi
1Department of Cardiology, Himeji Cardiovascular Center, Japan.
Insights
Atrial fibrillation (AF) in dilated cardiomyopathy (DCM) patients correlated with improved left ventricular (LV) function and better survival rates. Early antiarrhythmic therapy is recommended for DCM patients with AF.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- The impact of atrial rhythm on the clinical course of DCM requires further investigation.
- Atrial fibrillation (AF) is a common arrhythmia in patients with cardiovascular disease.
Purpose of the Study:
- To evaluate the relationship between atrial rhythm and the clinical outcomes in patients with dilated cardiomyopathy.
- To assess the effect of atrial fibrillation on left ventricular (LV) function and survival in DCM patients.
- To determine if left ventricular dysfunction associated with AF in DCM is reversible.
Main Methods:
- Retrospective analysis of 147 patients diagnosed with DCM.
- Classification of patients into sinus rhythm (SR) and atrial fibrillation (AF) groups (transient or persistent).
- Comparison of demographic, hemodynamic, and echocardiographic parameters; assessment of NYHA functional class and survival rates over a mean follow-up of 3.8 years.
Main Results:
- 24% of DCM patients had AF (transient or persistent).
- AF patients had larger left atria but similar LV dimensions and hemodynamic parameters compared to SR patients.
- AF patients showed significant improvement in NYHA functional class (56% vs 27%, p < 0.01) and a better 5-year survival rate (93% vs 68%, p < 0.05).
- LV function improved significantly in AF patients, especially with transient or rate-controlled AF, while remaining unchanged in SR patients.
- Reversible LV dysfunction was observed in some AF patients after arrhythmia control.
Conclusions:
- Atrial fibrillation in DCM patients is associated with improved LV function and enhanced survival.
- Left ventricular dysfunction in DCM may be significantly influenced by atrial rhythm and is potentially reversible with arrhythmia management.
- Aggressive antiarrhythmic therapy should be strongly considered for DCM patients diagnosed with atrial fibrillation.
Abstract:
We evaluated the relation of atrial rhythm to a clinical course of treatment in 147 patients diagnosed with dilated cardiomyopathy (DCM). Thirty-six of the patients (24%) had either transient (9 patients) or persistent (27 patients) atrial fibrillation (AF). Compared with DCM patients with sinus rhythm (SR), the AF patients did not differ in age, left ventricular (LV) dimension, fractional shortening, or hemodynamic parameters, but the AF patients had slightly larger left atria. After a mean follow-up of 3.8 +/- 2.9 years, the NYHA functional classifications in the AF patients improved in 20 of the 36 (56%), whereas those of the SR patients improved in only 30 (27%) (p < 0.01). The actuarial 5-year survival rate was significantly better for AF patients than for SR patients (93% versus 68%, p < 0.05). LV function remained unchanged in SR patients but improved significantly in AF patients, particularly in patients with transient AF and with "rate-controlled" AF (those with a mean heart rate of less than 90 beats/min). This study suggests that atrial fibrillation may result in significant LV dysfunction, which is reversible in some cases once the arrhythmia is controlled. Aggressive antiarrhythmic therapy should be considered for patients initially diagnosed with dilated cardiomyopathy and atrial fibrillation.