Impact of successful restoration of sinus rhythm in patients with atrial fibrillation and acute heart failure: Results from the Korean Acute Heart Failure registry

Youngjin Cho, Il Young Oh, Jin Joo Park, Byung Hee Oh, Eun Seok Jeon, Jae Joong Kim, Kyung Kuk Hwang, Myeong Chan Cho, Shung Chull Chae, Sang Hong Baek, Seok Min Kang, Byung Su Yoo, Youngkeun Ahn, Dong Ju Choi

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Restoring and maintaining sinus rhythm (SR) in patients with atrial fibrillation (AF) failed to show superior outcomes over rate control strategies in prior randomized trials. However, there is sparse data on their outcomes in patients with acute heart failure (AHF). Methods: From December 2010 to February 2014, 5,625 patients with AHF from 10 tertiary hospi-tals were enrolled in the Korean Acute Heart Failure registry, including 1,961 patients whose initial electrocardiogram showed AF. Clinical outcomes of patients who restored SR by pharmacological or electrical cardioversion (SR conversion group, n = 212) were compared to those of patients who showed a persistent AF rhythm (AF persistent group, n = 1,662). Results: All-cause mortality both in-hospital and during the follow-up (median 2.5 years) were significantly lower in the SR conversion group than in the AF persistent group after adjustment for risk factors (adjusted hazard ratio [HR]; 95% confidence interval [CI] = 0.26 [0.08–0.88], p = 0.031 and 0.59 [0.43–0.82], p = 0.002, for mortality in-hospital and during follow-up, respectively). After 1:3 propensity score matching (SR conversion group = 167, AF persistent group = 501), successful restoration of SR was associated with lower all-cause mortality (HR [95% CI] = 0.68 [0.49–0.93], p = 0.015), heart failure rehospitalization (HR [95% CI] = 0.66 [0.45–0.97], p = 0.032), and compos-ite of death and heart failure rehospitalization (HR [95% CI] = 0.66 [0.51–0.86], p = 0.002). Conclusions: Patients with AHF and AF had significantly lower mortality in-hospital and during follow-up if rhythm treatment for AF was successful, underscoring the importance of restoring SR in patients with AHF. (Cardiol J 2022; 29, 3: 472–480).

Original languageEnglish
Pages (from-to)472-480
Number of pages9
JournalCardiology journal
Volume29
Issue number3
DOIs
StatePublished - 31 May 2022
Externally publishedYes

Keywords

  • acute heart failure
  • atrial fibrillation
  • cardioversion

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