Prognostic significance of atrial fibrillation in patients at a tertiary medical center referred for heart transplantation because of severe heart failure

Atrial fibrillation (AF) occurs frequently in advanced heart failure. The p rognostic significance of AF remains controversial. To determine the relati on of AF to survival in patients with advanced heart failure, 234 consecuti ve patients referred for heart transplantation evaluation from January 1993 to June 1996 were studied to determine the effect of AF on event-free surv ival (freedom from death, heart transplantation, or placement of a left ven tricular assist device). Clinical characteristics of the study population i ncluded: age, 51 +/- 17 years; maximum exercise oxygen consumption, 14.2 +/ - 5.3 ml/kg/ min; left ventricular ejection fraction, 24 +/- 11%; pulmonary capillary wedge pressure, 23 +/- 9 mm Hg; and ischemic etiology, 52%. Medi cal therapy included: diuretics (86%), angiotensin-converting enzyme inhibi tors (80%), digoxin (80%), and anticoagulation therapy (72%). Mean duration of follow-up was 1.1 +/- 1.0 years. Sixty-two patients (27.4%) had AF. One -year event-free survival of the study population was 48%. No difference in event-free survival between patients with and without AF was observed. Uni variate predictors of decreased event-free survival included: (1) advanced New York Heart Association class; (2) higher pulmonary capillary wedge pres sure; (3) lower cardiac index; (4) lower maximum exercise oxygen consumptio n; (5) use of inotropic therapy; and (6) greater pulmonary artery systolic pressure. By multivariate analysis, independent predictors of decreased eve nt-free survival included advanced New York Heart Association class (p <0.0 02) and higher pulmonary capillary wedge pressure (p = 0.02). Thus, AF in p atients with advanced heart failure is not associated with decreased event- free survival. (C) 1999 by Excerpta Medica, Inc.