Management of Atrial Fibrillation Suppression in AF-HF Comorbidity Therapy (MASCOT) Trial

  • M. G. Bongiorni
  • G. Giannola
  • G. Arena
  • E. Soldati
  • L. Padeletti
  • A. Puglisi
  • A. Curnis
  • S. Favale
  • A. Carboni
  • E. Hoffmann
  • M. Mariani
Conference paper


Inter- [1,2], intra- [3,4], and atrioventricular [51(AV) dyssynchrony are not new concepts, but only recently have attempts been made to correct these disorders in an effort to treat heart failure (HF). A series of trials [6] has addressed partial or comprehensive cardiac resynchronization in patients with severe HF and evidence of cardiac dyssynchrony. Cardiac resynchronization should improve left ventricular (LV) performance; several trials [7-10] have demonstrated improvement in many hemodynamic parameters (LV and aortic pressure, shortening of mitral diastolic regurgitation, synchronized LV and atrial systole, LV volume, reduced myocardial oxygen consumption) and clinical end-points (quality of life, peak oxygen uptake, functional capacity, reduced number of hospitalizations). The incidence of atrial fibrillation (AF) double every 10 years in adults: there are 2-3 new cases/1000 annually in the age group of 55-64 years and 35 new cases/1000 annually between the age of 85 and 94 years [11-13]. The Framingham study demonstrated that AF is an independent risk factor for mortality with a relative risk of 1.5 for men and 1.9 for women. In patients with HF, the prevalence of AF is directly related to NYHA class: AF is present in 10% of patients in NYHA class II and 40% of patients in NYHA classes III-IV. However, HF morbidity is highly influenced by the coexistence of AF, independently of functional class. Moreover, the presence of symptomatic or asymptomatic AF in patients with LV dysfunction is linked to a poor prognosis and is independently associated with a higher risk of death from all causes and from progressive pump failure [14,15]. The prevalence of AF in most trials [16-22] on HF is shown in Fig. 1.


Atrial Fibrillation NYHA Class Atrial Systole Asymptomatic Atrial Fibrillation Cardiac Dyssynchrony 
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Copyright information

© Springer-Verlag Italia 2003

Authors and Affiliations

  • M. G. Bongiorni
    • 1
  • G. Giannola
    • 2
  • G. Arena
    • 1
  • E. Soldati
    • 1
  • L. Padeletti
    • 3
  • A. Puglisi
    • 4
  • A. Curnis
    • 5
  • S. Favale
    • 6
  • A. Carboni
    • 7
  • E. Hoffmann
    • 2
  • M. Mariani
    • 1
  1. 1.Cardiothoracic DepartmentCisanello Hospital, University of PisaItaly
  2. 2.Division of CardiologyPolyclinic Hospital, University of PalermoItaly
  3. 3.Ospedale CareggiFlorenceItaly
  4. 4.Ospedale FatebenefratelliRomeItaly
  5. 5.Spedali CiviliBresciaItaly
  6. 6.Policlinico ConsorzialeBariItaly
  7. 7.Ospedale CivileParmaItaly

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