The burden of atrial fibrillation and its prognostic value in patients with dilated cardiomyopathy.

BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia in dilated cardiomyopathy (DCM). The epidemiology, clinical and prognostic significance of AF in DCM are poorly defined. AIMS Analyse AF impact and prognostic role in DCM, explore the concept of AF-induced DCM. METHODS Hospital records of 285 DCM patients from 2012-2018 were analysed. RESULTS AF was present in 89 (31%) patients who were older, more frequently male, had higher BMI, NYHA class, heart rate (HR), creatinine, larger atria (all p < 0.05) than non-AF patients. During a follow-up [35 (24) months] 20 (24%) out of 82 patients with AF and 22 (12%) out of 188 patients without AF died (p = 0.007). AF was independently associated with worse outcome (HR 2.4 [95%CI 1.3-4.3]). AF was found to be the major cause of DCM in 21 patients (24%). These patients experienced: shorter duration of symptoms and QRS, were of a lower NYHA class, smaller left ventricle, higher HR, haemoglobin and LDL, required lower furosemide doses. The diagnostic accuracy of the most optimal predictive model for AF-DCM, consisting of DCM duration, NYHA class, HR and haemoglobin was 0.935 [95%CI 0.903-0.967]. Despite numerical differences, survival in AF-DCM was similar to DCM with AF (p = 0.15). CONCLUSIONS Almost one-third of DCM patients suffered from AF. Most of the parameters analysed differentiate patients with and without AF. AF was found to be an independent prognostic factor in DCM. One-fourth of DCM patients with AF met the criteria for the diagnosis of AF-DCM.

[1]  A. Undas,et al.  Atrial fibrillation and rapid atrial pacing are linked to enhanced inflammation and altered fibrinolysis in patients undergoing pulmonary vein isolation. , 2018, Kardiologia polska.

[2]  A. Sokal,et al.  NOninvasive Monitoring for Early Detection of Atrial Fibrillation: rationale and design of the NOMED-AF study. , 2018, Kardiologia polska.

[3]  A. Camm,et al.  The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. , 2018, European heart journal.

[4]  P. Ponikowski,et al.  [2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure]. , 2016, Kardiologia polska.

[5]  P. Kirchhof,et al.  2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. , 2016, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[6]  S. Heymans,et al.  Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases. , 2016, European heart journal.

[7]  M. Peller,et al.  Clinical characteristics and predictors of one-year outcome of heart failure patients with atrial fibrillation compared to heart failure patients in sinus rhythm. , 2015, Kardiologia polska.

[8]  Jianfeng Huang,et al.  The prognostic significance of atrial fibrillation in heart failure with a preserved and reduced left ventricular function: insights from a meta‐analysis , 2014, European journal of heart failure.

[9]  W. Roberts,et al.  Morphologic Features of the Recipient Heart in Patients Having Cardiac Transplantation and Analysis of the Congruence or Incongruence Between the Clinical and Morphologic Diagnoses , 2014, Medicine.

[10]  Alireza Ahmadi,et al.  Tachycardia-induced cardiomyopathy , 2014, ARYA atherosclerosis.

[11]  G. Fonarow,et al.  Associations between atrial fibrillation and early outcomes of patients with heart failure and reduced or preserved ejection fraction. , 2014, American heart journal.

[12]  P. Gurbel,et al.  Antiplatelet and anticoagulant agents in heart failure: current status and future perspectives. , 2014, JACC. Heart failure.

[13]  G. Barbati,et al.  Impact of Atrial Fibrillation on Outcome of Patients with Idiopathic Dilated Cardiomyopathy: Data from the Heart Muscle Disease Registry of Trieste , 2010, Clinical Medicine & Research.

[14]  M. Banach,et al.  Influence of co-existing atrial fibrillation on the efficacy of atorvastatin treatment in patients with dilated cardiomyopathy: a pilot study , 2010, Lipids in Health and Disease.

[15]  J. Kalman,et al.  Tachycardia-mediated cardiomyopathy secondary to focal atrial tachycardia: long-term outcome after catheter ablation. , 2009, Journal of the American College of Cardiology.

[16]  H. Ross,et al.  Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy. , 2009, The Canadian journal of cardiology.

[17]  C. Schneider,et al.  ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: application of natriuretic peptides. , 2008, European heart journal.

[18]  Eloisa Arbustini,et al.  Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. , 2007, European heart journal.

[19]  H. Sawada,et al.  Characteristics of congestive heart failure accompanied by atrial fibrillation with special reference to tachycardia-induced cardiomyopathy. , 2007, Circulation journal : official journal of the Japanese Circulation Society.

[20]  Karl Swedberg,et al.  Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET. , 2005, European heart journal.

[21]  M. Viitanen,et al.  Poor Outcome After First-Ever Stroke: Predictors for Death, Dependency, and Recurrent Stroke Within the First Year , 2003, Stroke.

[22]  G. Kay,et al.  Tachycardia-related cardiomyopathy: a common cause of ventricular dysfunction in patients with atrial fibrillation referred for atrioventricular ablation. , 2000, Mayo Clinic proceedings.

[23]  R. Sung.  Incessant Supraventricular Tachycardia , 1983, Pacing and clinical electrophysiology : PACE.