Atrial Fibrillation in Heart Failure: Prognostic Significance and Management

  • G. V. Naccarelli
  • B. J. Hynes
  • D. Wolbrette
  • M. Khan
  • L. Bhatta
  • S. Samii
  • J. Luck
Conference paper


Patients with congestive heart failure (CHF) have a poor prognosis and are at increased risk of dying suddenly or from progressive pump dysfunction. Atrial and ventricular arrhythmias commonly occur in patients with CHF and are a significant source of symptoms, morbidity, and mortality. Atrial fibrillation occurs in up to 9% of patients over the age of 80 and in 15%–X30% of patients with CHF [1]. The prevalence of atrial fibrillation increases with progression of NYHA heart failure class from less than 10% in NYHA class I to almost 50% in NYHA class IV CHF [2].


Atrial Fibrillation Sinus Rhythm Congestive Heart Failure Patient Maintain Sinus Rhythm Atrial Fibrilla 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hynes BJ, Luck JC, Wolbrette DL et al (2003) Atrial fibrillation in patients with heart failure. Curr Opin Cardiol 18:32–38PubMedCrossRefGoogle Scholar
  2. 2.
    Maisel WH, Stevenson LW (2003) Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol 91:2D–8DPubMedCrossRefGoogle Scholar
  3. 3.
    Benjamin EJ, Wolf PA, D’Agostino RB et al (1998) Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98: 946–952PubMedCrossRefGoogle Scholar
  4. 4.
    Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE (1995) The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba follow-up study. Am J Med 98:476–484PubMedCrossRefGoogle Scholar
  5. 5.
    Middlekauff HR, Stevenson WG, Stevenson LW (1991) Prognostic significance of atrial fibrillation in advanced heart failure: a study of 390 patients. Circulation 84:40–48PubMedCrossRefGoogle Scholar
  6. 6.
    Carson PE, Johnson GR, Dunkman WB et al, for the V-HeFT VA Cooperative Studies Group (1993) The influence of atrial fibrillation on prognosis in mild to moderate heart failure. Circulation 87:VI102–V110.PubMedGoogle Scholar
  7. 7.
    Dries DL, Exner DV, Gersh BJ et al (1998) Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. J Am Coll Cardiol 32:695–703.PubMedCrossRefGoogle Scholar
  8. 8.
    Stevenson WG, Stevenson LW, Middlekauff HR et al (1996) Improving survival for patients with atrial fibrillation and advanced heart failure. J Am Coll Cardiol 28:1458PubMedCrossRefGoogle Scholar
  9. 9.
    Mahoney P, Kimmel S, DeNofrio D, Wahl P, Loh E (1999) Prognostic significance of atrial fibrillation in patients at a tertiary medical center referred for heart transplantation because of severe heart failure. Am J Cardiol 83:1544–1547PubMedCrossRefGoogle Scholar
  10. 10.
    Mathew J, Hunsberger S, Fleg J et al, for the Digitalis Investigative Group (2000) Incidence, predictive factors, and prognostic significance of supraventricular tachyarrhythmias in congestive heart failure. Chest 118:914–922PubMedCrossRefGoogle Scholar
  11. 11.
    Brignole M, Menozzi C, Giafranchi L et al (1998) Assessment of atrioventricular junction ablation and WIR pacemaker versus pharmacologic treatment in patients with heart failure and chronic atrial fibrillation. Circulation 98:953–960PubMedCrossRefGoogle Scholar
  12. 12.
    The Atrial Fibrillation Follow-Up Investigations of Rhythm Management (AFFIRM) Investigators (2002) A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 347:1825–1833CrossRefGoogle Scholar
  13. 13.
    Roy D, for the AF-CHF Trial Investigators (2002) The Atrial Fibrillation and Congestive Heart Failure Trial (abstract). Europace 3:A–11Google Scholar
  14. 14.
    Roy D, Talajic M, Dorian P et al, for the Canadian Trial of Atrial Fibrillation Investigators (2000) Amiodarone to prevent recurrence of atrial fibrillation. N Engl J Med 342: 913–920PubMedCrossRefGoogle Scholar
  15. 15.
    Naccarelli GV, Wolbrette DL, Khan M et al (2003) Old and new antiarrhythmic drugs for converting and maintaining sinus rhythm in atrial fibrillation: comparative efficacy and results of trials. Am J Cardiol 91:15D–26DPubMedCrossRefGoogle Scholar
  16. 16.
    Fuster V, Rydén LE, Asinger RW, Cannom DS et al (2001) ACC/AH A/ESC guidelines for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences. (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 38:1231–1265PubMedCrossRefGoogle Scholar
  17. 17.
    Deedwania PC, Singh BN, Ellenbogen K et al, for the Department of Veterans Affairs CHF-STAT Investigators (1998) Spontaneous conversion and maintenance of sinus rhythm by amiodarone in patients with heart failure and atrial fibrillation. Observation for the veterans affairs congestive heart failure survival trial of antiarrhythmic therapy (CHF-STAT). Circulation 98:2574–2579PubMedCrossRefGoogle Scholar
  18. 18.
    Torp-Pederson C, Moller M, Bloch-Thomsen PE et al (1999) Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group. N Engl J Med 341:857–865CrossRefGoogle Scholar
  19. 19.
    Pederson OD, Bagger H, Keller N et al, for the Danish Investigations of Arrhythmia and Mortality ON Dofetilide Study Group (2001) Efficacy of dofetilide in the treatment of atrial fibrillation-flutter in patients with reduced left ventricular function: a Danish Investigations of Arrhythmia and Mortality ON Dofetilide (DIAMOND) sub-study. Circulation 104:292–296CrossRefGoogle Scholar
  20. 20.
    San Fillippo AJ, Abascol VM, Sheehan M et al (1990) Atrial enlargement as a consequence of atrial fibrillation: a prospective echocardiographic study. Circulation 82:792–797CrossRefGoogle Scholar
  21. 21.
    Solti F, Vecsey T, Kékesi V, Juhász-Nagy A (1989) The effect of atrial dilatation on the genesis of atrial arrhythmias. Cardiovasc Res 23:882–886PubMedCrossRefGoogle Scholar
  22. 22.
    Tomaselli GF, Marbán E (1999) Electrophysiological remodeling in hypertrophy and heart failure. Cardiovasc Res 42:270–283PubMedCrossRefGoogle Scholar
  23. 23.
    Allessie MA, Boyden PA, Camm AJ et al (2001) Pathophysiology and prevention of atrial fibrillation. Circulation 103:769–777PubMedCrossRefGoogle Scholar
  24. 24.
    Nakashima H, Kumagai K, Urata H et al (2000) Angiotensin II antagonist prevents electrical remodeling in atrial fibrillation. Circulation 101:2612–2617PubMedCrossRefGoogle Scholar
  25. 25.
    Goette A, Arndt M, Rocken C et al (2000) Regulation of angiotensin II receptor subtypes during atrial fibrillation in humans. Circulation 101:2678–2681PubMedCrossRefGoogle Scholar
  26. 26.
    Pederson OD, Bagger H, Kober L, Torp-Pedersen C (1999) Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation 100:376–380CrossRefGoogle Scholar
  27. 27.
    Madrid AH, Bueno MG, Rebollo JMG et al (2002) Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation. A prospective and randomized study. Circulation 106:331–336Google Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • G. V. Naccarelli
    • 1
  • B. J. Hynes
    • 1
  • D. Wolbrette
    • 1
  • M. Khan
    • 1
  • L. Bhatta
    • 1
  • S. Samii
    • 1
  • J. Luck
    • 1
  1. 1.Division of Cardiology and the Penn State Cardiovascular CenterPenn State University College of MedicineHersheyUSA

Personalised recommendations