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Clinical Investigations: CARDIOLOGY |

In Patients With Chronic Atrial Fibrillation and Left Ventricular Systolic Dysfunction, Restoration of Sinus Rhythm Confers Substantial Benefit*

José Azpitarte, FESC; Oscar Baún, MD; Eduardo Moreno, MD; Rocío García-Orta, MD; Jesús Sánchez-Ramos, MD; Luis Tercedor, MD
Author and Funding Information

*From the Division of Cardiology, Virgen de las Nieves University Hospital, Granada, Spain.

Correspondence to: José Azpitarte, MD, Division of Cardiology, Virgen de las Nieves University Hospital, Av de las Fuerzas Armadas 2, 18014 Granada, Spain; e-mail: jazpitarte@lettera.net



Chest. 2001;120(1):132-138. doi:10.1378/chest.120.1.132
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Study objectives: To evaluate the benefit of sinus rhythm (SR) restoration in patients with chronic controlled atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD).

Design: Prospective case-control study on the short-term outcome (6 to 9 months) of clinical and echocardiographic variables following attempted cardioversion.

Setting: Outpatient clinic of a university hospital.

Patients: Fifteen men and 5 women, ranging in age from 40 to 76 years, who had chronic controlled (mean [± SD] ventricular rate, 82 ± 10 beats/min) AF and left ventricular fractional shortening (LVFS) of< 28% at baseline. Control was provided by retrospective paired echocardiographic examinations of six AF patients, plus the study cases with potentially unsuccessful cardioversion or early recurrence of AF.

Interventions: Attempt to restore SR with amiodarone or electrical countershock.

Measurements and results: Conversion was attained in 17 patients, but AF recurred early in 4 patients, 3 of whom had proven ischemic LVSD. In the 13 patients with sustained SR, LVFS increased from 20 ± 4% to 31 ± 6% (p < 0.0001). In contrast, no changes were detected in the control group (n = 13). This improvement was paralleled by decreases in left ventricular (LV) end-diastolic dimension (from 55 ± 7 to 51 ± 6 mm; p = 0.014), LV mass (from 181 ± 28 to 159 ± 37 g; p = 0.015), and left atrial diameter (from 45 ± 9 mm to 42 ± 7; p = 0.003). A marked decrease in heart rate (from 82 ± 9 to 64 ± 5 beats/min; p < 0.0001) and a reduction in New York Heart Association functional class (from 2.3 ± 0.9 to 1.2 ± 0.4; p = 0.0007) also were observed in patients with sustained SR but not among subjects in the control group.

Conclusions: Even when adequate control of the ventricular rate has been achieved, the LV function of patients with chronic AF greatly improves after restoration and maintenance of SR.

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