Abstract 11250: Long-term Outcomes for Patients With Atrial fibrillation and a Rapid Ventricular Response: A Comparison of Those With Reduced Versus Preserved Ejection Fraction at Initial Hospitalization

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Background: Patients presenting with new onset atrial fibrillation with rapid ventricular response (AFRVR) may present with a reduced left ventricular ejection fraction (LVEF). We hypothesized that these patients have worse outcomes than patients presenting with preserved LVEF. Methods: Retrospective cohort study of 385 consecutive patients with new onset AFRVR, presenting between 01/2006 and 08/2014. Patients with a history of coronary artery disease or known cardiomyopathy were excluded. Patients were divided into those with reduced EF (REF) (LVEF ≤ 55%, n=147), and those with a preserved EF (PEF) (LVEF> 55%, n=238). Echocardiographic parameters, stroke rates, all-cause, and cardiovascular mortality were compared at baseline and a minimum of 1 year follow-up. Results: Mean age was 68 +/- 1.1 in REF versus 60 +/- 7.4 in PEF (p=0.39). There were no significant differences in baseline comorbidities. Mean LVEF was 47.7+/- 0.8% in REF vs 65.5 +/- 0.3% in PEF. The average duration of follow-up was 2.8 years. REF patients had higher all-cause mortality (32.7% REF vs 20.6% PEF, OR 2.17, p= 0.008) but similar cardiovascular mortality (15% REF vs 15.1% PEF, p=0.97). REF patients had higher rates of subsequent clinic or ER visits for AFRVR (32% REF vs 22.7% PEF, p=0.044). The incidence of stroke was similar between both groups (17% REF vs 18.9% PEF, p=0.639). Of REF patients, 29.7% had subsequent EF recovery; this subset had similar outcomes compared to PEF patients. Baseline left ventricular end diastolic diameter (LVEDD) predicted all-cause mortality (OR 1.14, p=0.003) in REF group. None of the echocardiographic parameters predicted EF recovery. Conclusion: In this cohort of patients with new AFRVR, REF was associated with higher long-term all-cause mortality and AFRVR recurrence. Those with subsequent LVEF recovery after medical therapy appear to have outcomes similar to those with PEF.