Abstract 4863: Rhythm Versus Rate Control Strategies In Heart Failure Patients With Atrial Fibrillation: Impact On Lv Function And Functional Status: Echocardiographic Insights From Af-chf

Abstract

Background: In heart failure patients, the recently published AF-CHF (Atrial Fibrillation in Congestive Heart Failure) trial did not demonstrate the superiority of a rhythm control (RhyC) over a rate control (RaC) strategy in terms of cardiovascular mortality. Nevertheless, the deleterious hemodynamic effects of AF can lead to further decrease in LV function and symptoms progression. This AF-CHF echocardiographic sub-study was designed to compare the effects of the two treatment strategies (RhyC and RaC) on LV ejection fraction (LVEF), chamber dimensions and volumes, valvular regurgitation, functional status and exercise tolerance. Methods: 59 patients (29 RhyC:30 RaC) enrolled in AF-CHF were prospectively followed in this echocardiography study, with a standardized exam at baseline and 12 months. The primary endpoint was the change in LVEF. Results: (Table 1 ) Mean LVEF at baseline was severely depressed (RhyC:27.0±4.9% and RaC:27.6±7.4%, p=0.73), with significant improvement at follow-up for both groups. Other echocardiographic parameters were unchanged at follow-up, including changes in LV and LA volumes and valvular regurgitation. Clinically, mean six-minute walked distance increased significantly in both groups as did NYHA class without any additional benefit for the rhythm control strategy (both p=NS). Conclusion: In patients with HF and AF, improvements in LVEF and functional status are observed at 12 months without any additional benefit of rhythm control over a rate control strategy.