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 O Coffey; Raul D Mitrani; Valentin Fuster; Juan F Viles-Gonzalez

doi:10.1016/j.ijcard.2014.04.011

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

Journal article

Peer reviewed

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, …

International journal of cardiology, Vol.174(2), pp.288-292

06/15/2014

DOI: 10.1016/j.ijcard.2014.04.011

PMID: 24794553

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Abstract

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. 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). In rhythm control arm, median time to recurrence in patients with concentric LVH was 13.3months (95% CI 8.2–24.5) vs. 28.3months (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). 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.

Rhythm control

Hospitalization

Atrial fibrillation

Left ventricular hypertrophy

Details

Title: Subtitle: Influence of left ventricular remodeling on atrial fibrillation recurrence and cardiovascular hospitalizations in patients undergoing rhythm-control therapy
Creators: Neeraj Shah - Staten Island University Hospital, Staten Island, NY, United States
Apurva O Badheka - Detroit Medical Center, Detroit, MI, United States
Peeyush M Grover - University of Miami Miller School of Medicine, Miami, FL, United States
Nileshkumar J Patel - Staten Island University Hospital, Staten Island, NY, United States
Ankit Chothani - Washington Hospital Center, Washington, DC, United States
Kathan Mehta - Drexel University School of Public Health, Philadelphia, PA, United States
Michael Hoosien - University of Miami Miller School of Medicine, Miami, FL, United States
Vikas Singh - University of Miami Miller School of Medicine, Miami, FL, United States
Ghanshyambhai T Savani - University of Miami Miller School of Medicine, Miami, FL, United States
Abhishek Deshmukh - University of Arkansas, Little Rock, AR, United States
Ankit Rathod - Cedar Sinai Medical Center, Los Angeles, CA, United States
Nilay Patel - Detroit Medical Center, Detroit, MI, United States
Sidakpal S Panaich - Detroit Medical Center, Detroit, MI, United States
Shilpkumar Arora - Detroit Medical Center, Detroit, MI, United States
Charles Schwartz - Staten Island University Hospital, Staten Island, NY, United States
Martin Blisker - University of Miami Miller School of Medicine, Miami, FL, United States
James O Coffey - University of Miami Miller School of Medicine, Miami, FL, United States
Raul D Mitrani - University of Miami Miller School of Medicine, Miami, FL, United States
Valentin Fuster - The Mount Sinai Medical Center, NY, United States
Juan F Viles-Gonzalez - University of Miami Miller School of Medicine, Miami, FL, United States
Resource Type: Journal article
Publication Details: International journal of cardiology, Vol.174(2), pp.288-292
DOI: 10.1016/j.ijcard.2014.04.011
PMID: 24794553
NLM abbreviation: Int J Cardiol
ISSN: 0167-5273
eISSN: 1874-1754
Publisher: Elsevier Ireland Ltd
Language: English
Date published: 06/15/2014
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984094529002771

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