Influence of left ventricular remodeling on atrial fibrillation recurrence and cardiovascular hospitalizations in patients undergoing rhythm-control therapy

Neeraj Shah, Apurva O. Badheka, Peeyush M. Grover, Nileshkumar J. Patel, Ankit Chothani, Kathan Mehta, Michael Hoosien, Vikas Singh, Ghanshyambhai T. Savani, Abhishek Deshmukh, Ankit Rathod, Nilay Patel, Sidakpal S. Panaich, Shilpkumar Arora, Charles Schwartz, Martin Blisker, James Odell Coffey, Raul D. Mitrani, Valentin Fuster, Juan F. Viles-Gonzalez

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Background Atrial fibrillation (AF) patients with left ventricular hypertrophy (LVH) and diastolic dysfunction may derive benefit from being in sinus rhythm but no data are available to support this strategy in them. We sought to investigate effect of left ventricular remodeling on cardiovascular outcomes in AF patients undergoing rhythm control strategy. Methods We identified 1088 patients with echocardiographic data on left ventricular mass (LVM) enrolled in the AFFIRM trial. Using the American Society of Echocardiography (ASE) criteria, patients were divided into 4 categories: 1) normal geometry, 2) concentric remodeling, 3) eccentric hypertrophy, and 4) concentric hypertrophy. The primary endpoint was AF recurrence and the secondary endpoint was cardiovascular hospitalization (CVH). Results In rhythm control arm, median time to recurrence in patients with concentric LVH was 13.3 months (95% CI 8.2-24.5) vs. 28.3 months (95% CI 20.2-48.6) in patients without LVH. Concentric left ventricular hypertrophy (LVH) was independently predictive of AF recurrence (HR 1.49, 95% CI 1.10-2.01, p = 0.01) in rhythm control arm, but not in overall population or rate control arm. Both concentric and eccentric LVH were independently predictive of cardiovascular hospitalization (CVH) in the overall population, with respective HRs of 1.36 (1.04-1.78, p = 0.03) and 1.38 (1.02-1.85, p = 0.04). Conclusion Concentric LVH is predictive of AF recurrences when a predominantly pharmacologic rhythm-control strategy is employed. Different patterns of LVH seem to be important determinants of outcomes (AF recurrence and CVH). These findings may have important clinical implications for the management of patients with AF and LVH. Further studies are warranted to confirm our findings.

Original languageEnglish (US)
Pages (from-to)288-292
Number of pages5
JournalInternational Journal of Cardiology
Volume174
Issue number2
DOIs
StatePublished - Jun 15 2014

Keywords

  • Atrial fibrillation
  • Hospitalization
  • Left ventricular hypertrophy
  • Rhythm control

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Shah, N., Badheka, A. O., Grover, P. M., Patel, N. J., Chothani, A., Mehta, K., Hoosien, M., Singh, V., Savani, G. T., Deshmukh, A., Rathod, A., Patel, N., Panaich, S. S., Arora, S., Schwartz, C., Blisker, M., Coffey, J. O., Mitrani, R. D., Fuster, V., & Viles-Gonzalez, J. F. (2014). Influence of left ventricular remodeling on atrial fibrillation recurrence and cardiovascular hospitalizations in patients undergoing rhythm-control therapy. International Journal of Cardiology, 174(2), 288-292. https://doi.org/10.1016/j.ijcard.2014.04.011