ATRIAL-FIBRILLATION IS ASSOCIATED WITH AN INCREASED RISK FOR MORTALITY AND HEART-FAILURE PROGRESSION IN PATIENTS WITH ASYMPTOMATIC AND SYMPTOMATIC LEFT-VENTRICULAR SYSTOLIC DYSFUNCTION - A RETROSPECTIVE ANALYSIS OF THE SOLVD TRIALS

Objective. This study undertook to determine if the presence of atrial fibrillation in patients with asymptomatic and symptomatic left ventr icular dysfunction was associated with increased mortality and, if so, whether the increase could be attributed to progressive heart failure or arrhythmic death. Background Atrial fibrillation is a common condi tion in heart failure with the potential to impact hemodynamics and pr ogression of left ventricular systolic dysfunction as well as the elec trophysiologic substrate for arrhythmias. The available data do not co nclusively define the effect of atrial fibrillation on prognosis in he art failure. Methods. A retrospective analysis of the Studies of Left Ventricular Dysfunction Prevention and Treatment Trials was con ducted that compared patients with atrial fibrillation to those in sinus rhy thm at baseline for the risk of all-cause mortality, progressive pump- failure death and arrhythmic death. Results. The patients with atrial fibrillation at baseline, compared to those in sinus rhythm, had great er all cause mortality (34% vs. 23%, p < 0.001), death attributed to p ump-failure (16.7% vs. 9.4%, p < 0.001) and were more likely to reach the composite end point of death or hospitalization for heart failure (45% vs. 33%, p < 0.001), but there was no significant difference betw een the groups in arrhythmic deaths. After multivariate analysis, atri al fibrillation remained significantly associated with all-cause morta lity (relative risk [RR] 1.34, 95% confidence interval [CI] 1.12 to 1. 62, p = 0.002), progressive pump-failure death (RR 1.42, 95% CI 1.09 t o 1.85, p = 0.01), the composite end point of death or hospitalization for heart failure (RR 1.26, 95% CI 1.03 to 1.42, p = 0.02), but not a rrhythmic death (RR 1.13; 95% CI 0.75 to 1.71; p = 0.55). Conclusions. The presence of atrial fibrillation in patients with asymptomatic and symptomatic left ventricular systolic dysfunction is associated with an increased risk for all-cause mortality, largely explained by an inc reased risk for pump-failure death. These data suggest that atrial fib rillation is associated with progression of left ventricular systolic dysfunction. (J Am Cell Cardiol 1998;32:695-703) (C) 1998 by the Ameri can College of Cardiology.