CLINICAL STUDIES
Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials
DanielL Dries, MD, MPH*  ,
DerekV Exner, MD,
BernardJ Gersh, MB, DPhil, ChB,
MichaelJ Domanski, MD*,
MyronA Waclawiw, PhD and
LynneW Stevenson, MD
* Clinical Trials Scientific Research Group, The National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
Georgetown University Hospital, Washington, DC, USA
Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
The Brigham and Women’s Hospital, Boston, Massachusetts, USA
Manuscript received February 12, 1998;
revised manuscript received May 11, 1998,
accepted May 20, 1998.
Address for correspondence: Dr. Daniel L. Dries, Clinical Trials Scientific Research Group, Division of Epidemiology and Clinical Applications, National Heart, Lung and Blood Institute, II Rockledge Center, Room 8149, 6701 Rockledge Drive, Bethesda, Maryland 20892
Ddries{at}aol.com
Objective. This study undertook to determine if the presence of atrial fibrillation in patients with asymptomatic and symptomatic left ventricular dysfunction was associated with increased mortality and, if so, whether the increase could be attributed to progressive heart failure or arrhythmic death.
Background. Atrial fibrillation is a common condition in heart failure with the potential to impact hemodynamics and progression of left ventricular systolic dysfunction as well as the electrophysiologic substrate for arrhythmias. The available data do not conclusively define the effect of atrial fibrillation on prognosis in heart failure.
Methods. A retrospective analysis of the Studies of Left Ventricular Dysfunction Prevention and Treatment Trials was conducted that compared patients with atrial fibrillation to those in sinus rhythm at baseline for the risk of all-cause mortality, progressive pump-failure death and arrhythmic death.
Results. The patients with atrial fibrillation at baseline, compared to those in sinus rhythm, had greater all-cause mortality (34% vs. 23%, p < 0.001), death attributed to pump-failure (16.7% vs. 9.4%, p < 0.001) and were more likely to reach the composite end point of death or hospitalization for heart failure (45% vs. 33%, p < 0.001), but there was no significant difference between the groups in arrhythmic deaths. After multivariate analysis, atrial fibrillation remained significantly associated with all-cause mortality (relative risk [RR] 1.34, 95% confidence interval [CI] 1.12 to 1.62, p = 0.002), progressive pump-failure death (RR 1.42, 95% CI 1.09 to 1.85, p = 0.01), the composite end point of death or hospitalization for heart failure (RR 1.26, 95% CI 1.03 to 1.42, p = 0.02), but not arrhythmic death (RR 1.13; 95% CI 0.75 to 1.71; p = 0.55).
Conclusions. The presence of atrial fibrillation in patients with asymptomatic and symptomatic left ventricular systolic dysfunction is associated with an increased risk for all-cause mortality, largely explained by an increased risk for pump-failure death. These data suggest that atrial fibrillation is associated with progression of left ventricular systolic dysfunction.
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Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction
Eur. Heart J.,
February 1, 2006;
27(3):
290 - 295.
[Abstract]
[Full Text]
[PDF]
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M. Rienstra, I. C. Van Gelder, V. E. Hagens, N. J.G.M. Veeger, D. J. Van Veldhuisen, H. J.G.M. Crijns, and for the RACE Investigators
Mending the rhythm does not improve prognosis in patients with persistent atrial fibrillation: a subanalysis of the RACE study
Eur. Heart J.,
February 1, 2006;
27(3):
357 - 364.
[Abstract]
[Full Text]
[PDF]
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P. A. Gould, M. Yii, M. D. Esler, J. M. Power, and D. M. Kaye
Atrial fibrillation impairs cardiac sympathetic response to baroreceptor unloading in congestive heart failure
Eur. Heart J.,
December 1, 2005;
26(23):
2562 - 2567.
[Abstract]
[Full Text]
[PDF]
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J. S. Floras
Atrial fibrillation and cardiac sympathetic reflexes in heart failure
Eur. Heart J.,
December 1, 2005;
26(23):
2490 - 2492.
[Full Text]
[PDF]
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G. V. Naccarelli
Antiadrenergic Therapy in the Control of Atrial Fibrillation
Journal of Cardiovascular Pharmacology and Therapeutics,
October 1, 2005;
10(4_suppl):
S33 - S43.
[Abstract]
[PDF]
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R. K. Wolf, E. W. Schneeberger, R. Osterday, D. Miller, W. Merrill, J. B. Flege Jr, and A. M. Gillinov
Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation
J. Thorac. Cardiovasc. Surg.,
September 1, 2005;
130(3):
797 - 802.
[Abstract]
[Full Text]
[PDF]
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A. Verma, A. Natale, B. J. Padanilam, E. N. Prystowsky, A. Verma, A. Natale, B. J. Padanilam, and E. N. Prystowsky
Why Atrial Fibrillation Ablation Should Be Considered First-Line Therapy for Some Patients
Circulation,
August 23, 2005;
112(8):
1214 - 1222.
[Full Text]
[PDF]
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A. C.P. Wiesfeld, M. E.W. Hemels, J. P. Van Tintelen, M. P. Van den Berg, D. J. Van Veldhuisen, and I. C. Van Gelder
Genetic aspects of atrial fibrillation
Cardiovasc Res,
August 15, 2005;
67(3):
414 - 418.
[Abstract]
[Full Text]
[PDF]
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S. E. Shoaf, M. V. Elizari, Z. Wang, K. Sekar, L. R. Grinfeld, N. A. Barbagelata, J. Lerman, S. L. Bramer, J. Tronge, and C. Orlandi
Tolvaptan Administration Does Not Affect Steady State Amiodarone Concentrations in Patients With Cardiac Arrhythmias
Journal of Cardiovascular Pharmacology and Therapeutics,
July 1, 2005;
10(3):
165 - 171.
[Abstract]
[PDF]
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C Berry, K Hogg, J Norrie, K Stevenson, M Brett, and J McMurray
Heart failure with preserved left ventricular systolic function: a hospital cohort study
Heart,
July 1, 2005;
91(7):
907 - 913.
[Abstract]
[Full Text]
[PDF]
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K. Swedberg, L. G. Olsson, A. Charlesworth, J. Cleland, P. Hanrath, M. Komajda, M. Metra, C. Torp-Pedersen, and P. Poole-Wilson
Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET
Eur. Heart J.,
July 1, 2005;
26(13):
1303 - 1308.
[Abstract]
[Full Text]
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P. Zimetbaum
An Argument for Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation
Circulation,
June 14, 2005;
111(23):
3150 - 3156.
[Full Text]
[PDF]
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K. Wachtell, B. Hornestam, M. Lehto, D. J. Slotwiner, E. Gerdts, M. H. Olsen, P. Aurup, B. Dahlof, H. Ibsen, S. Julius, et al.
Cardiovascular morbidity and mortality in hypertensive patients with a history of atrial fibrillation: The Losartan Intervention For End point reduction in hypertension (LIFE) study
J. Am. Coll. Cardiol.,
March 1, 2005;
45(5):
705 - 711.
[Abstract]
[Full Text]
[PDF]
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C. L. O'Brien and B. F. Gage
Costs and Effectiveness of Ximelagatran for Stroke Prophylaxis in Chronic Atrial Fibrillation
JAMA,
February 9, 2005;
293(6):
699 - 706.
[Abstract]
[Full Text]
[PDF]
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F. Gustafsson, C. B. Kragelund, C. Torp-Pedersen, M. Seibaek, H. Burchardt, D. Akkan, J. J. Thune, L. Kober, and for the DIAMOND study group
Effect of obesity and being overweight on long-term mortality in congestive heart failure: influence of left ventricular systolic function
Eur. Heart J.,
January 1, 2005;
26(1):
58 - 64.
[Abstract]
[Full Text]
[PDF]
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H. Bihan, C. Espinosa, H. Valdes-Socin, S. Salenave, J. Young, S. Levasseur, P. Assayag, A. Beckers, and P. Chanson
Long-Term Outcome of Patients with Acromegaly and Congestive Heart Failure
J. Clin. Endocrinol. Metab.,
November 1, 2004;
89(11):
5308 - 5313.
[Abstract]
[Full Text]
[PDF]
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A. Abidov, R. Hachamovitch, A. Rozanski, S. W. Hayes, M. M. Santos, M. G. Sciammarella, I. Cohen, J. Gerlach, J. D. Friedman, G. Germano, et al.
Prognostic implications of atrial fibrillation in patients undergoing myocardial perfusion single-photon emission computed tomography
J. Am. Coll. Cardiol.,
September 1, 2004;
44(5):
1062 - 1070.
[Abstract]
[Full Text]
[PDF]
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B. P. Knight, A. Desai, J. Coman, M. Faddis, and P. Yong
Long-term retention of cardiac resynchronization therapy
J. Am. Coll. Cardiol.,
July 7, 2004;
44(1):
72 - 77.
[Abstract]
[Full Text]
[PDF]
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Y.-M. Cha, M. M. Redfield, W.-K. Shen, and B. J. Gersh
Atrial Fibrillation and Ventricular Dysfunction: A Vicious Electromechanical Cycle
Circulation,
June 15, 2004;
109(23):
2839 - 2843.
[Full Text]
[PDF]
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A. Ahmed, P. Thornton, G. J. Perry, R. M. Allman, and J. F. DeLong
Impact of atrial fibrillation on mortality and readmission in older adults hospitalized with heart failure
Eur J Heart Fail,
June 1, 2004;
6(4):
421 - 426.
[Abstract]
[Full Text]
[PDF]
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J. S. Kalus, C. M. White, M. F. Caron, C. I. Coleman, H. Takata, and J. Kluger
Indicators of atrial fibrillation risk in cardiac surgery patients on prophylactic amiodarone
Ann. Thorac. Surg.,
April 1, 2004;
77(4):
1288 - 1292.
[Abstract]
[Full Text]
[PDF]
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R.J. Shelton, G.C. Kaye, and J.G.F. Cleland
Controlling persistent atrial fibrillation
QJM,
March 1, 2004;
97(3):
179 - 180.
[Full Text]
[PDF]
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G. Djaiani, B. Phillips-Bute, M. Podgoreanu, R. H. Messier, J. P. Mathew, F. Clements, and M. F. Newman
The Association of Patent Foramen Ovale and Atrial Fibrillation After Coronary Artery Bypass Graft Surgery
Anesth. Analg.,
March 1, 2004;
98(3):
585 - 589.
[Abstract]
[Full Text]
[PDF]
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B. Ruo, A. M. Capra, N. G. Jensvold, and A. S. Go
Racial variation in the prevalence of atrial fibrillation among patients with heart failure: the Epidemiology, Practice, Outcomes, and Costs of Heart Failure (EPOCH) study
J. Am. Coll. Cardiol.,
February 4, 2004;
43(3):
429 - 435.
[Abstract]
[Full Text]
[PDF]
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C. W. Israel, G. Gronefeld, J. R. Ehrlich, Y.-G. Li, and S. H. Hohnloser
Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: Implications for optimal patient care
J. Am. Coll. Cardiol.,
January 7, 2004;
43(1):
47 - 52.
[Abstract]
[Full Text]
[PDF]
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A. Quesada, J.ús Almendral, F. Arribas, R. Ricci, C. Wolpert, P. Adragao, E. Cobo, X. Navarro, and on behalf DATAS investigators
The DATAS rationale and design: a controlled, randomized trial to assess the clinical benefit of dual chamber (DDED) defibrillator
Europace,
January 1, 2004;
6(2):
142 - 150.
[Abstract]
[Full Text]
[PDF]
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T. Deneke, T. Lawo, B. Gerritse, B. Lemke, and for the European GEM DRTM Investigators
Mortality of patients with implanted cardioverter/defibrillators in relation to episodes of atrial fibrillation
Europace,
January 1, 2004;
6(2):
151 - 158.
[Abstract]
[Full Text]
[PDF]
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M. P. van den Berg, I. C. van Gelder, and D. J. van Veldhuisen
Depletion of atrial natriuretic peptide during longstanding atrial fibrillation
Europace,
January 1, 2004;
6(5):
433 - 437.
[Abstract]
[Full Text]
[PDF]
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J. K. Ghali, H. J. Krause-Steinrauf, K. F. Adams Jr, S. S. Khan, Y. D. Rosenberg, C. W. Yancy Jr, J. B. Young, S. Goldman, M. A. Peberdy, and J. Lindenfeld
Gender differences in advanced heart failure: insights from the BEST study
J. Am. Coll. Cardiol.,
December 17, 2003;
42(12):
2128 - 2134.
[Abstract]
[Full Text]
[PDF]
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R. W Troughton, C. R Asher, and A. L Klein
The role of echocardiography in atrial fibrillation and cardioversion
Heart,
December 1, 2003;
89(12):
1447 - 1454.
[Full Text]
[PDF]
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P. A Gould, M. D Esler, and D. M Kaye
Chronic atrial fibrillation does not influence the magnitude of sympathetic overactivity in patients with heart failure
Eur. Heart J.,
September 2, 2003;
24(18):
1657 - 1662.
[Abstract]
[Full Text]
[PDF]
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G.C. Gronefeld and S.H. Hohnloser
Quality of life in atrial fibrillation: an increasingly important issue
Eur. Heart J. Suppl.,
September 1, 2003;
5(suppl_H):
H25 - H33.
[Abstract]
[PDF]
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T. S. M. Tsang, G. W. Petty, M. E. Barnes, W. M. O'Fallon, K. R. Bailey, D. O. Wiebers, J. D. Sicks, T. J. H. Christianson, J. B. Seward, and B. J. Gersh
The prevalence of atrial fibrillation in incident stroke cases and matched population controls in Rochester, Minnesota: Changes over three decades
J. Am. Coll. Cardiol.,
July 2, 2003;
42(1):
93 - 100.
[Abstract]
[Full Text]
[PDF]
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T. J. Wang, M. G. Larson, D. Levy, R. S. Vasan, E. P. Leip, P. A. Wolf, R. B. D'Agostino, J. M. Murabito, W. B. Kannel, and E. J. Benjamin
Temporal Relations of Atrial Fibrillation and Congestive Heart Failure and Their Joint Influence on Mortality: The Framingham Heart Study
Circulation,
June 17, 2003;
107(23):
2920 - 2925.
[Abstract]
[Full Text]
[PDF]
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E. Vermes, J.-C. Tardif, M. G. Bourassa, N. Racine, S. Levesque, M. White, P. G. Guerra, and A. Ducharme
Enalapril Decreases the Incidence of Atrial Fibrillation in Patients With Left Ventricular Dysfunction: Insight From the Studies Of Left Ventricular Dysfunction (SOLVD) Trials
Circulation,
June 17, 2003;
107(23):
2926 - 2931.
[Abstract]
[Full Text]
[PDF]
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T. J. Wang, D. Levy, E. J. Benjamin, and R. S. Vasan
The Epidemiology of "Asymptomatic" Left Ventricular Systolic Dysfunction: Implications for Screening
Ann Intern Med,
June 3, 2003;
138(11):
907 - 916.
[Abstract]
[Full Text]
[PDF]
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G. C. Gronefeld and S. H. Hohnloser
Heart Failure Complicated by Atrial Fibrillation: Mechanistic, Prognostic, and Therapeutic Implications
Journal of Cardiovascular Pharmacology and Therapeutics,
June 1, 2003;
8(2):
107 - 113.
[Abstract]
[PDF]
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