What does this research mean for the field?

Rhythm-control strategy in patients with atrial fibrillation and left ventricular dysfunction or congestive heart failure improves physical ability compared to rate-control strategy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

The study aims to compare the impact of atrial fibrillation on thromboembolic events and congestive heart failure development, and evaluate which control strategy improves physical ability.

March 1, 2026

Treatment strategy in patients with non-valvular atrial fibrillation and congestive heart failure

Key Result

Permanent AF increased stroke and CHF risk, worsened NYHA class and EF, supporting rhythm-control strategy in AF patients with LV dysfunction or CHF.

Key Points

The study aims to compare the impact of atrial fibrillation on thromboembolic events and congestive heart failure development, and evaluate which control strategy improves physical ability.
Enrolled 952 patients divided into four groups based on the type of atrial fibrillation (first, recurrent paroxysmal, recurrent persistent, and permanent).
Utilized statistical analysis to evaluate p-values for significance in events and physical outcomes.
Measured ejection fraction and New York Heart Association (NYHA) class to assess functional ability.
Permanent atrial fibrillation was linked to a higher frequency of thromboembolic events (p < 0.01).
Recurrent persistent atrial fibrillation had significantly more thromboembolic events than first episode AF (p < 0.05).
Patients with permanent and recurrent persistent AF experienced significantly worse congestive heart failure outcomes (p < 0.01).
A notable percentage (61.7%) of patients with persistent AF were in NYHA class III, indicating substantial physical limitation.

Structured PICO

Does the type and duration of atrial fibrillation affect the development of thromboembolism and heart failure severity in patients with non-valvular AF?

Population

Patients with non-valvular atrial fibrillation and congestive heart failure

Intervention

Permanent or recurrent persistent atrial fibrillation (observational exposure)

Comparator

First episode or recurrent paroxysmal atrial fibrillation

Outcome

Development of thromboembolism (TE), congestive heart failure (CHF), and physical ability (NYHA class)hard clinical

Permanent and persistent atrial fibrillation are associated with worse heart failure symptoms, lower ejection fraction, and higher rates of thromboembolism compared to paroxysmal or first-episode AF, supporting a rhythm-control strategy in these patients.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Frequent episodes of atrial fibrillation (AF) is associated with increased rates of death, stroke and other TE, CHF and hospitalizations. In clinical trials have shown no improvement in survival and no clinical advantages between rhythm and rate control strategies. Purpose: to compare influence of AF on development of TE and CHF, and to ascertain whether rhythm or rate control ensure best physical ability. Methods: A total of 952 pts were enrolled in the study: group 1 – first episode of AF (168 pts-17.6%), group 2 – recurrent paroxysmal AF of ≤48 hours (428 pts-45.0%), group 3 - recurrent persistent AF, >48 hours (141 pts-14.8%), group 4 – permanent AF (215 pts-22.6%). P-value of <0,05 was considered to indicate statistical significance. Results: History of TE events occurred more frequently in pts with permanent AF (p < 0.01), whereas in pts with recurrent persistent AF, TE were significantly more frequent when compared with the patients with the first AF (p < 0.05). The permanent AF most frequently provoked stroke when compared with patients experiencing first or paroxysmal recurrent AF (p < 0.01). Permanent and recurrent persistent AF resulted in development of significant CHF (p < 0.01). Worsening of the NYHA class was related to duration of AF episode: 61.7% pts with persistent recurrent AF were in NYHA class III (p < 0.01) and 15.4% pts with permanent AF were in NYHA class IV (p < 0.01) when compared with groups 1 and 2. The permanent AF decrease of EF (p < 0.01). Conclusion: Our data advocates rhythm-control strategy in pts with AF and LV dysfunction or CHF, as permanent AF resulted in reduced physical ability and cause the worse of CHF.

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