Association between clinical outcome and antiarrhythmic treatment in heart failure patients who have atrial fibrillation upon admission to the hospital

Eiichi Watanabe, Tomoharu Arakawa, Kentarou Okuda, Mayumi Yamamoto, Tomohide Ichikawa, Hiroto Harigaya, Yoshihiro Sobue, Yukio Ozaki

Research output: Contribution to journalArticle

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Abstract

Background: Atrial fibrillation (AF) and heart failure (HF) are associated with significant mortality and morbidity. We sometimes encounter patients who have AF upon admission to the hospital, but it spontaneously converts to sinus rhythm within several days (i.e. converter). Purpose: We examined the association between the outcome and types of strategy for AF treatment in converters. Methods: From January 2000 to December 2005, we identified 95 converters (age 69. ± 12 years) presenting with worsening HF and AF upon admission, in which sinus rhythm was restored within 7 days without either electrical or pharmacological cardioversion. The patients were classified into three groups according to the antiarrhythmic drug (AAD) therapy used: class I AAD, class III AAD, and rate-control drug. The patients were followed for 36. ± 23 months. Results: The left ventricular ejection fraction (LVEF) significantly improved with conversion to sinus rhythm (38. ± 14% vs. 47. ± 13%, p< 0.05). Those receiving class I AAD had a trend toward a well-preserved LVEF (50. ± 13%, n= 35) as compared to those receiving class III AAD (43. ± 12%, n= 24) or rate-control drug (47. ± 14%, n= 36). In the patients receiving class I AAD, the rate of all-cause death increased 1.9-fold (p= 0.009) compared to those receiving class III AAD, and 1.7-fold (p= 0.010) compared to those taking rate-control drug. A hospitalization for HF was observed in 49 (52%) patients, however there was no significant difference in the rate of hospitalization among the three groups (p= 0.890). Those receiving rate-control drugs had a 50% lower rate of the development of persistent AF than those taking class III AAD (p= 0.019). Conclusions: A rate-control strategy should be the primary approach for converters to reduce mortality and development of persistent AF.

Original languageEnglish
Pages (from-to)31-35
Number of pages5
JournalJournal of cardiology
Volume60
Issue number1
DOIs
Publication statusPublished - 01-07-2012

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Anti-Arrhythmia Agents
Atrial Fibrillation
Heart Failure
Drug and Narcotic Control
Stroke Volume
Hospitalization
Electric Countershock
Mortality
Cause of Death
Pharmacology
Morbidity
Drug Therapy
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Watanabe, Eiichi ; Arakawa, Tomoharu ; Okuda, Kentarou ; Yamamoto, Mayumi ; Ichikawa, Tomohide ; Harigaya, Hiroto ; Sobue, Yoshihiro ; Ozaki, Yukio. / Association between clinical outcome and antiarrhythmic treatment in heart failure patients who have atrial fibrillation upon admission to the hospital. In: Journal of cardiology. 2012 ; Vol. 60, No. 1. pp. 31-35.
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title = "Association between clinical outcome and antiarrhythmic treatment in heart failure patients who have atrial fibrillation upon admission to the hospital",
abstract = "Background: Atrial fibrillation (AF) and heart failure (HF) are associated with significant mortality and morbidity. We sometimes encounter patients who have AF upon admission to the hospital, but it spontaneously converts to sinus rhythm within several days (i.e. converter). Purpose: We examined the association between the outcome and types of strategy for AF treatment in converters. Methods: From January 2000 to December 2005, we identified 95 converters (age 69. ± 12 years) presenting with worsening HF and AF upon admission, in which sinus rhythm was restored within 7 days without either electrical or pharmacological cardioversion. The patients were classified into three groups according to the antiarrhythmic drug (AAD) therapy used: class I AAD, class III AAD, and rate-control drug. The patients were followed for 36. ± 23 months. Results: The left ventricular ejection fraction (LVEF) significantly improved with conversion to sinus rhythm (38. ± 14{\%} vs. 47. ± 13{\%}, p< 0.05). Those receiving class I AAD had a trend toward a well-preserved LVEF (50. ± 13{\%}, n= 35) as compared to those receiving class III AAD (43. ± 12{\%}, n= 24) or rate-control drug (47. ± 14{\%}, n= 36). In the patients receiving class I AAD, the rate of all-cause death increased 1.9-fold (p= 0.009) compared to those receiving class III AAD, and 1.7-fold (p= 0.010) compared to those taking rate-control drug. A hospitalization for HF was observed in 49 (52{\%}) patients, however there was no significant difference in the rate of hospitalization among the three groups (p= 0.890). Those receiving rate-control drugs had a 50{\%} lower rate of the development of persistent AF than those taking class III AAD (p= 0.019). Conclusions: A rate-control strategy should be the primary approach for converters to reduce mortality and development of persistent AF.",
author = "Eiichi Watanabe and Tomoharu Arakawa and Kentarou Okuda and Mayumi Yamamoto and Tomohide Ichikawa and Hiroto Harigaya and Yoshihiro Sobue and Yukio Ozaki",
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Association between clinical outcome and antiarrhythmic treatment in heart failure patients who have atrial fibrillation upon admission to the hospital. / Watanabe, Eiichi; Arakawa, Tomoharu; Okuda, Kentarou; Yamamoto, Mayumi; Ichikawa, Tomohide; Harigaya, Hiroto; Sobue, Yoshihiro; Ozaki, Yukio.

In: Journal of cardiology, Vol. 60, No. 1, 01.07.2012, p. 31-35.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association between clinical outcome and antiarrhythmic treatment in heart failure patients who have atrial fibrillation upon admission to the hospital

AU - Watanabe, Eiichi

AU - Arakawa, Tomoharu

AU - Okuda, Kentarou

AU - Yamamoto, Mayumi

AU - Ichikawa, Tomohide

AU - Harigaya, Hiroto

AU - Sobue, Yoshihiro

AU - Ozaki, Yukio

PY - 2012/7/1

Y1 - 2012/7/1

N2 - Background: Atrial fibrillation (AF) and heart failure (HF) are associated with significant mortality and morbidity. We sometimes encounter patients who have AF upon admission to the hospital, but it spontaneously converts to sinus rhythm within several days (i.e. converter). Purpose: We examined the association between the outcome and types of strategy for AF treatment in converters. Methods: From January 2000 to December 2005, we identified 95 converters (age 69. ± 12 years) presenting with worsening HF and AF upon admission, in which sinus rhythm was restored within 7 days without either electrical or pharmacological cardioversion. The patients were classified into three groups according to the antiarrhythmic drug (AAD) therapy used: class I AAD, class III AAD, and rate-control drug. The patients were followed for 36. ± 23 months. Results: The left ventricular ejection fraction (LVEF) significantly improved with conversion to sinus rhythm (38. ± 14% vs. 47. ± 13%, p< 0.05). Those receiving class I AAD had a trend toward a well-preserved LVEF (50. ± 13%, n= 35) as compared to those receiving class III AAD (43. ± 12%, n= 24) or rate-control drug (47. ± 14%, n= 36). In the patients receiving class I AAD, the rate of all-cause death increased 1.9-fold (p= 0.009) compared to those receiving class III AAD, and 1.7-fold (p= 0.010) compared to those taking rate-control drug. A hospitalization for HF was observed in 49 (52%) patients, however there was no significant difference in the rate of hospitalization among the three groups (p= 0.890). Those receiving rate-control drugs had a 50% lower rate of the development of persistent AF than those taking class III AAD (p= 0.019). Conclusions: A rate-control strategy should be the primary approach for converters to reduce mortality and development of persistent AF.

AB - Background: Atrial fibrillation (AF) and heart failure (HF) are associated with significant mortality and morbidity. We sometimes encounter patients who have AF upon admission to the hospital, but it spontaneously converts to sinus rhythm within several days (i.e. converter). Purpose: We examined the association between the outcome and types of strategy for AF treatment in converters. Methods: From January 2000 to December 2005, we identified 95 converters (age 69. ± 12 years) presenting with worsening HF and AF upon admission, in which sinus rhythm was restored within 7 days without either electrical or pharmacological cardioversion. The patients were classified into three groups according to the antiarrhythmic drug (AAD) therapy used: class I AAD, class III AAD, and rate-control drug. The patients were followed for 36. ± 23 months. Results: The left ventricular ejection fraction (LVEF) significantly improved with conversion to sinus rhythm (38. ± 14% vs. 47. ± 13%, p< 0.05). Those receiving class I AAD had a trend toward a well-preserved LVEF (50. ± 13%, n= 35) as compared to those receiving class III AAD (43. ± 12%, n= 24) or rate-control drug (47. ± 14%, n= 36). In the patients receiving class I AAD, the rate of all-cause death increased 1.9-fold (p= 0.009) compared to those receiving class III AAD, and 1.7-fold (p= 0.010) compared to those taking rate-control drug. A hospitalization for HF was observed in 49 (52%) patients, however there was no significant difference in the rate of hospitalization among the three groups (p= 0.890). Those receiving rate-control drugs had a 50% lower rate of the development of persistent AF than those taking class III AAD (p= 0.019). Conclusions: A rate-control strategy should be the primary approach for converters to reduce mortality and development of persistent AF.

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