Optimal heart failure therapy and successful cardioversion in heart failure patients with atrial fibrillation

Item Type:	Article
Title:	Optimal heart failure therapy and successful cardioversion in heart failure patients with atrial fibrillation
Creators Name:	Boldt, L.H. and Rolf, S. and Huemer, M. and Parwani, A.S. and Luft, F.C. and Dietz, R. and Haverkamp, W.
Abstract:	BACKGROUND: Effectiveness, safety, and other factors associated with success of cardioversion (CV) of atrial fibrillation (AF) have not yet been evaluated in patients with reduced left ventricular ejection fraction. We studied 148 consecutive patients with left ventricular dysfunction (ejection fraction < or = 45%), who underwent electrical CV for AF in our department. The patients had New York Heart Association heart failure ranging from class II to IV. The overall CV success rate was 71%. We relied on univariate and multivariate regression and sought variables influencing success rate. Conversion success did not correlate with New York Heart Association class. Instead, we found that the greatest predictor was the degree of heart failure treatment. Patients receiving beta-blockers, angiotensin-converting enzyme inhibitors or angiotension receptor blockers, plus mineralocorticoid receptor blockers had the greatest chance for conversion success. Success was more likely in patients with coronary artery disease (91%) than in patients with nonischemic cardiomyopathy. CONCLUSIONS: Cardioversion is a safe and effective method for the restoration of sinus rhythm in patients with AF and reduced left ventricular ejection fraction. Our findings underscore the value of aggressive heart failure treatment before CV in patients with AF.
Keywords:	Adrenergic beta-Antagonists, Angiotensin II Type 1 Receptor Blockers, Angiotensin-Converting Enzyme Inhibitors, Atrial Fibrillation, Electric Countershock, Heart Failure, Stroke Volume, Treatment Outcome, Left Ventricular Dysfunction
Source:	American Heart Journal
ISSN:	0002-8703
Publisher:	Elsevier
Volume:	155
Number:	5
Page Range:	890-895
Date:	May 2008
Official Publication:	https://doi.org/10.1016/j.ahj.2007.12.015
PubMed:	View item in PubMed

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