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Low Atrial Fibrillatory Rate Is Associated with Poor Outcome in Patients with Mild to Moderate Heart Failure.

Platonov, Pyotr LU ; Cygankiewicz, Iwona; Stridh, Martin; Holmqvist, Fredrik LU ; Vazquez, Rafael; Bayes-Genis, Antoni; McNitt, Scott; Zareba, Wojciech and Bayes de Luna, Antonio (2012) In Circulation: Arrhythmia and Electrophysiology 5(1). p.77-83
Abstract
BACKGROUND: -Atrial fibrillatory rate (AFR) is a measure of atrial remodeling caused by atrial fibrillation (AF) and its acceleration negatively affects outcome of interventions for persistent AF. However, the prognostic value of AFR in patients with CHF has not been studied. We sought to evaluate whether AFR can predict outcome in patients with mild to moderate (NYHA II-III) congestive heart failure (CHF). METHODS AND RESULTS: -High-resolution 20-min long Holter ECGs obtained from 169 CHF patients with AF at enrollment were analyzed. AFR was estimated using spatiotemporal QRST cancellation and time-frequency analysis. The patients were followed for a median of 44 months with primary endpoint defined as total mortality and secondary... (More)
BACKGROUND: -Atrial fibrillatory rate (AFR) is a measure of atrial remodeling caused by atrial fibrillation (AF) and its acceleration negatively affects outcome of interventions for persistent AF. However, the prognostic value of AFR in patients with CHF has not been studied. We sought to evaluate whether AFR can predict outcome in patients with mild to moderate (NYHA II-III) congestive heart failure (CHF). METHODS AND RESULTS: -High-resolution 20-min long Holter ECGs obtained from 169 CHF patients with AF at enrollment were analyzed. AFR was estimated using spatiotemporal QRST cancellation and time-frequency analysis. The patients were followed for a median of 44 months with primary endpoint defined as total mortality and secondary endpoints as sudden death and heart failure death. Atrial signal quality was sufficient for AFR estimation in 142 patients (mean age 69±11 years, 101 male). Of those, 48 patients died during follow-up, including 18 due to CHF progression. Mean AFR was 390±60 fpm and decreased with age (r=-0.3, p<0.001). Patients with AFR≤371 fpm (lower tertile) had 44% 3-year mortality as compared to 26% with higher AFR. Lower AFR was an independent predictor of all cause mortality (HR=1.99, 95% CI=1.09-3.63, p=0.025) and CHF death (HR=3.74, 95% CI=1.38-10.14, p=0.010) after adjustment for significant clinical covariates in multivariable Cox analysis. CONCLUSIONS: -In CHF patients with AF, reduced AFR assessed using non-invasive approach is associated with increased risk of death due to heart failure progression and may be considered as a predictor of outcome. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Circulation: Arrhythmia and Electrophysiology
volume
5
issue
1
pages
77 - 83
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000300613000016
  • pmid:22235036
  • scopus:84858312913
ISSN
1941-3084
DOI
10.1161/CIRCEP.111.964395
language
English
LU publication?
yes
id
cd285cdc-d81d-4414-815e-5734ad9e7fb6 (old id 2336532)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22235036?dopt=Abstract
date added to LUP
2012-02-01 20:32:33
date last changed
2017-03-19 04:17:27
@article{cd285cdc-d81d-4414-815e-5734ad9e7fb6,
  abstract     = {BACKGROUND: -Atrial fibrillatory rate (AFR) is a measure of atrial remodeling caused by atrial fibrillation (AF) and its acceleration negatively affects outcome of interventions for persistent AF. However, the prognostic value of AFR in patients with CHF has not been studied. We sought to evaluate whether AFR can predict outcome in patients with mild to moderate (NYHA II-III) congestive heart failure (CHF). METHODS AND RESULTS: -High-resolution 20-min long Holter ECGs obtained from 169 CHF patients with AF at enrollment were analyzed. AFR was estimated using spatiotemporal QRST cancellation and time-frequency analysis. The patients were followed for a median of 44 months with primary endpoint defined as total mortality and secondary endpoints as sudden death and heart failure death. Atrial signal quality was sufficient for AFR estimation in 142 patients (mean age 69±11 years, 101 male). Of those, 48 patients died during follow-up, including 18 due to CHF progression. Mean AFR was 390±60 fpm and decreased with age (r=-0.3, p&lt;0.001). Patients with AFR≤371 fpm (lower tertile) had 44% 3-year mortality as compared to 26% with higher AFR. Lower AFR was an independent predictor of all cause mortality (HR=1.99, 95% CI=1.09-3.63, p=0.025) and CHF death (HR=3.74, 95% CI=1.38-10.14, p=0.010) after adjustment for significant clinical covariates in multivariable Cox analysis. CONCLUSIONS: -In CHF patients with AF, reduced AFR assessed using non-invasive approach is associated with increased risk of death due to heart failure progression and may be considered as a predictor of outcome.},
  author       = {Platonov, Pyotr and Cygankiewicz, Iwona and Stridh, Martin and Holmqvist, Fredrik and Vazquez, Rafael and Bayes-Genis, Antoni and McNitt, Scott and Zareba, Wojciech and Bayes de Luna, Antonio},
  issn         = {1941-3084},
  language     = {eng},
  number       = {1},
  pages        = {77--83},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Circulation: Arrhythmia and Electrophysiology},
  title        = {Low Atrial Fibrillatory Rate Is Associated with Poor Outcome in Patients with Mild to Moderate Heart Failure.},
  url          = {http://dx.doi.org/10.1161/CIRCEP.111.964395},
  volume       = {5},
  year         = {2012},
}