What is the clinical evidence from this study?

Study design: Cohort. Population: Dilated cardiomyopathy (n=147). Intervention: Atrial fibrillation vs. Sinus rhythm. Primary outcome: 5-year actuarial survival rate (p=<0.05).

January 1, 1993Open Access

Prognostic Significance of Atrial Fibrillation in Dilated Cardiomyopathy.

Q: What are the key findings of this study?

Atrial fibrillation in patients with dilated cardiomyopathy was associated with a significantly better 5-year survival rate (93%) compared to sinus rhythm (68%).

Resultado clave

Atrial fibrillation in patients with dilated cardiomyopathy was associated with a significantly better 5-year survival rate (93%) compared to sinus rhythm (68%).

Diseño del estudio

Tipo

Cohort (n=147)

Multicéntrico

PICO estructurado

Does atrial fibrillation affect survival and functional outcomes in patients with dilated cardiomyopathy?

Población

147 patients diagnosed with dilated cardiomyopathy (DCM)

Intervención

Atrial fibrillation (transient or persistent)

Comparador

Sinus rhythm

Resultado

NYHA functional classification improvement and actuarial 5-year survival ratehard clinical

In patients with dilated cardiomyopathy, the presence of atrial fibrillation is associated with better 5-year survival and greater improvement in NYHA class and LV function compared to sinus rhythm, likely due to a reversible tachycardia-induced component of LV dysfunction.

Resultado numérico

Tasa de eventos absoluta: 93% vs 68%

valor p: p=<0.05

Limitaciones

Beta-blockers and warfarin were used significantly more frequently in patients with atrial fibrillation.
Basal myocardial damage might have been milder in atrial fibrillation patients, as electrocardiographic abnormalities and myocardial biopsy findings were more severe in sinus rhythm patients.

Resumen

We evaluated the relation of atrial rhythm to a clinical course of treatment in 147 patients diagnosed with dilated cardiomyopathy (DCM). Thirty-six of the patients (24%) had either transient (9 patients) or persistent (27 patients) atrial fibrillation (AF). Compared with DCM patients with sinus rhythm (SR), the AF patients did not differ in age, left ventricular (LV) dimension, fractional shortening, or hemodynamic parameters, but the AF patients had slightly larger left atria. After a mean follow-up of 3.8 +/- 2.9 years, the NYHA functional classifications in the AF patients improved in 20 of the 36 (56%), whereas those of the SR patients improved in only 30 (27%) (p < 0.01). The actuarial 5-year survival rate was significantly better for AF patients than for SR patients (93% versus 68%, p < 0.05). LV function remained unchanged in SR patients but improved significantly in AF patients, particularly in patients with transient AF and with "rate-controlled" AF (those with a mean heart rate of less than 90 beats/min). This study suggests that atrial fibrillation may result in significant LV dysfunction, which is reversible in some cases once the arrhythmia is controlled. Aggressive antiarrhythmic therapy should be considered for patients initially diagnosed with dilated cardiomyopathy and atrial fibrillation.

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