Comparative effects of Statin and Renin-Angiotensin System Inhibitor on New-onset Atrial Fibrillation according to risk stratification of CHA2DS2-VASc score

초록

Background: It has been recently reported that a lowering atrial fibrillation (AF) burden in patients coexisting atrial fibrillation and heart failure with reduced ejection fraction was associated with lower rates of death from any cause and lower rates of hospitalization for heart failure. However, it is unclear whether sinus rhythm restoration is associated with all-cause mortality or hospital admission in AF patients with heart failure with mid-ranged ejection fraction (HFmrEF). Purpose: The aim of our study was to determine the impact of sinus rhythm (SR) restoration by antiarrhythmic drugs (AADs) on mortality or hospitalization in AF patients with HFmrEF during long-term follow-up. Methods: We enrolled 5,585 consecutive AF patients (≥19 years, mean age 66 ± 13 years, 41.1% female) in a tertiary hospital from 2007 to January 2017. Patients with a left ventricular ejection fraction (LVEF) in the range of 40?49% were defined as HFmrEF. AF patients with HFmrEF were divided into three groups according to history of SR conversion and rate control (heart rate target <100 bpm): group 1 (81 patients with history of SR restoration by AAD with rate control), group 2 (173 patients who had an only rate control (heart rate<100 bpm) without restoration of SR) and group 3 (94 patients who had a poorly controlled rate without restoration of SR).