New-onset Atrial Fibrillation Predicts Heart Failure Progression

BackgroundAtrial fibrillation and heart failure with reduced left ventricular ejection fraction have interrelated pathophysiologies. New-onset atrial fibrillation in heart failure patients has been associated with increased mortality, but has not been definitively related to clinical heart failure progression.MethodsTo test the hypothesis that new-onset atrial fibrillation is related to clinical heart failure progression, in 2392 patients without atrial fibrillation at randomization in the Beta-blocker Evaluation of Survival Trial we measured clinical endpoints in patients who did (Group 1, n = 190) or did not (Group 2, n = 2202) develop new-onset atrial fibrillation. Results were also compared with the 303 patients who entered the trial in atrial fibrillation (Baseline/chronic group), and in Group 1/2 patients we conducted a multivariate analysis of covariates potentially related to time to first heart failure hospitalization.ResultsCompared with Group 2, Group 1 patients post atrial fibrillation onset had a ∼2-fold increase in mortality (P < .0001) and a ∼4.5-fold increase in all-cause or heart failure hospitalization days/patient (hospitalization burden, both P < .0001). In Group 1, both types of hospitalization burden were 2.9-fold greater than in the Baseline/chronic group (P < .001), and hospitalization burden increased ∼6-fold (P < .0001) compared with the pre-event period. On multivariate analysis, new-onset atrial fibrillation was a highly significant (P < .00001) predictor of heart failure hospitalization.ConclusionsIn addition to being a discrete electrophysiologic event, in heart failure patients, new-onset atrial fibrillation is a predictor of and trigger for clinical heart failure progression.     

Atrial Fibrillation in Heart Failure: A Comprehensive Review

Chronic heart failure and atrial fibrillation are 2 major disorders that are closely linked. Their coexistence is associated with adverse prognosis. Both share several common predisposing conditions, but their interaction involves complex ultrastructural, electrophysiologic, and neurohormonal processes that go beyond mere sharing of mutual risk factors. Rate control approach remains the standard therapy for atrial fibrillation in heart failure because current strategies at rhythm control have so far failed to positively impact mortality and morbidity. This is largely because of the shortcomings of current pharmacologic anti-arrhythmic agents. Surgical and catheter-based therapies are promising, but long-term data are lacking. The role of non-anti-arrhythmic therapeutic agents also is being explored. Further progress toward improved understanding the complex relationship between atrial fibrillation and heart failure should improve management strategies.     

倍他乐克注射液对快室率房颤伴心衰的疗效观察

目的探讨倍他乐克注射液联合西地兰对房颤快速心室率伴心衰的疗效及安全性。方法对房颤伴心衰的患者,先给以西地兰0.2mg稀释后缓慢静注,观测半小时,如心率仍>100次/分、血压≥100/60mmHg以上的患者,予倍他乐克注射液10mg稀释后经微泵静注1小时,当心率≤60次/分、血压<90/60mmHg时停止;微泵静注倍他乐克前、后,观察症状、体征、心率、血压、肺部音、无创血流动力学和BNP、ANP等指标。结果用倍他乐克后心室率平均减少了23.73次/分(P<0.01),收缩压降低5.69mmHg(P<0.05),舒张压降低5.26mmHg(P<0.05),使用倍他乐克前后SI、SV、VI、SVRI、SVR、LVET有明显改变(P<0.05),BNP、ANP无显著变化。结论倍他乐克注射液联合西地兰治疗快室率房颤伴心衰是有效和安全的。     

射频导管消融与药物室率控制治疗心房颤动合并心力衰竭患者的疗效比较

目的比较射频导管消融（下称消融）的节律控制与药物室率控制对心房颤动患者心力衰竭的治疗效果。方法连续入选心房颤动合并心力衰竭患者35例（消融组）,同期选择年龄、性别、心房颤动类型、基础疾病、左心房前后径（LAD）、左心室舒张末期内径（LVEDd）、左心室射血分数（LVEF）相匹配的药物室率控制加抗凝治疗的患者35例（室率控制组）。结果随访（24±12）个月,消融术后,57%（20/35）的患者维持窦性心律。消融组与药物室率控制组比较,其中心血管死亡事件发生率（5.71%vs 8.57%）差异无统计学意义（P＞0.05）,缺血性脑卒中发生率（2.86%vs 20.00%）,NYHA心功能分级改善（68.57% vs 31.43%）,LAD改变幅度[（-8±8）mm vs（9±12）mm],LVEDd改变幅度[（-5±7）mm vs（0±7） mm],LVEF提高幅度[（21%±12）%vs（10%±15%）]差异均有统计学意义（均P＜0.05或0.01）。结论合并心力衰竭的心房颤动患者,经导管消融的节律控制优于药物室率控制。     

Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation.

AIMS: To describe atrial fibrillation (AF) management in member countries of the European Society of Cardiology (ESC) and to verify cardiology practices against guidelines. METHODS AND RESULTS: Among 182 hospitals in 35 countries, 5333 ambulant and hospitalized AF patients were enrolled, in 2003 and 2004. AF was primary or secondary diagnosis, and was confirmed on ECG in the preceding 12 months. Clinical type of AF was reported to be first detected in 978, paroxysmal in 1517, persistent in 1167, and permanent in 1547 patients. Concomitant diseases were present in 90% of all patients, causing risk factors for stroke to be also highly prevalent (86%). As many as 69% of patients were symptomatic at the time of the survey; among asymptomatic patients, 54% were previously experienced symptoms. Oral anticoagulation was prescribed in 67 and 49% of eligible and ineligible patients, respectively. A rhythm control strategy was applied in 67% of currently symptomatic patients and in 44% of patients who never experienced symptoms. CONCLUSION: This survey provides a unique snapshot of current AF management in ESC member countries. Discordance between guidelines and practice was found regarding several issues on stroke prevention and antiarrhythmic therapy.