Outcome of pharmacological rhythm control for new-onset persistent atrial fibrillation in patients with systolic heart failure: a comparison with patients with normal left ventricular function

AIMS: To compare outcome of a serial cardioversion strategy in atrial fibrillation (AF) patients with and without systolic heart failure (HF). METHODS AND RESULTS: In patients with new-onset persistent AF and systolic HF [left ventricular ejection fraction (LVEF) <0.40] outcome of a serial electrical cardioversion (ECV) and serial antiarrhythmic drug strategy was compared with a control group of patients without HF. Follow-up was 18 months. Sixty-four consecutive patients with systolic HF (mean age 64 +/- 12 years, 50% coronary artery disease, LVEF 0.30 +/- 0.07) were enrolled and compared with 48 consecutive patients without HF (mean age 66 +/- 8 years, all LVEF >0.50, 40% lone AF). Success of ECV and occurrence of subacute and late recurrences in patients with and without HF were comparable. After the first relapse, AF was accepted in significantly more HF patients (23 vs. 4%, P < 0.01). Significantly less HF patients underwent serial ECV and antiarrhythmic drug approach (42 vs. 71%, respectively, P < 0.001). At the end of follow-up more HF patients were in permanent AF (45 vs. 29%, P = 0.03). CONCLUSION: Recurrence pattern after ECV is comparable between patients with and without systolic HF, but outcome of a serial cardioversion strategy is worse in HF patients, possibly related to a less stringent use of this approach.