Long-term clinical impact of sinus rhythm restoration in atrial fibrillation patients with heart failure

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 allcause mortality or hospital admission in AF patients with heart failure with midranged 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 longterm followup. Results: There were no significant differences in age (p=0.305), female (p=0.930), LVEF (p=0.709) and the proportions of comorbidities including hypertension (p=0.679), diabetes mellitus (p=0.466) and prior stroke (p=0.284) among three each groups. The use of an angiotensinconverting enzyme inhibitor or angiotensin receptor blocker (p=0.591), oral anticoagulation (p=0.329) and antiplatelet agent (p=0.807) were similar among three groups. During 77±42 months followup, 2 (2.5%) patients in group 1 died from any cause compared with other groups [9 (5.2%) in group 2 and 19 (20.2%) in group 3, p<0.001). Significantly fewer patients in group 1 were hospitalized for worsening HF (12 (14.8%) in group 1, 43 (24.9%) in group 2, and 29 (30.9%) in group 3? p=0.038). KaplanMeier estimates showed a significant difference in any cause death or hospitalization between group 1 and group 3 (p<0.001). In Cox proportionalhazards models, after adjusting relevant risk factors, chronic kidney disease (hazards ratio [HR] 1.98, 95% confidence interval [CI] 1.24?3.17, p=0.004) and SR restoration (HR 0.44, 95% CI 0.25?0.80, p=0.007) were independently associated with mortality or hospitalization for worsening HF. Conclusion: Sinus restoration in AF patients with HFmrEF was associated with