Atrial fibrillation as a trigger for acute heart failure

Abstract

Abstract Background Both atrial fibrillation (AF) and heart failure (HF) facilitate the occurrence and aggravate the prognosis of each other, and often coexist (1). Rapid AF is considered to be a trigger for HF decompensation. However, rapid AF can also be secondary to the increase sympathetic drive associated with HF decompensation. Few data are available regarding the hemodynamic and metabolic consequences of rapid AF in acute HF. Purpose To study the clinical impact of rapid AF in acute HF. Methods We studied 8,997 patients admitted with acutely decompensated heart failure (ADHF). Propensity-score matching was generated using 21 clinical variables. The primary endpoint was in-hospital mortality. Results Rapid AF (defined as ventricular rate ≥110) at admission was present in 339 patients (3.8%). Patient with rapid AF had higher prevalence of diabetes, ischemic heart disease chronic lung disease, and higher levels of BUN and white blood cells (All P<0.001). Systolic blood pressure was lower and diastolic blood pressure was higher with rapid AF (Table). Blood lactate levels were slightly higher with rapid AF but the O2 saturation, pH, bicarbonate and pCO2 levels were similar (Table). In a multivariable logistic regression model, adjusting for all available clinical variables, the odds ration (OR) for in hospital mortality was 1.07 (95% CI 0.77 to 1.49; P=0.69). Propensity score matching yielded 338 patient pairs. In-hospital mortality occurred in 16.3% of patients with rapid AF and in 12.7% of patients without rapid AF ( OR 1.34; 95% CI 0.87 to 2.08, P= 0.19). Conclusion Rapid AF at admission was not associated with a significant hemodynamic or metabolic compromise and carried a similar risk for in-hospital mortality as in patients without rapid AF.Hemodynamic and metabolic parameters