Comparison of effect of rate control versus rhythm control on LV function in patients with AF and ischemic heart failure

Abstract

The effect of rate control and rhythm control on left ventricular (LV) function in patients (pts) with atrial fibrillation (AF) and ischemic (LV) failure need to be delineated. The study was conducted on 48 pts with persistent AF of more than one week and less than one year duration and ischemic LV failure (EF < 50%). They were randomized into two groups matched in age and gender. Group 1: 24 pts submitted to rate control treatment. Group 2: 24 pts submitted to rhythm control treatment. Exclusion criteria: previous thromboembolism, left atrial (LA) or LA appendage thrombi, LA > 60 mm, intractable heart failure. Myocardial performance index (Tei index) was determined. Rate control: was achieved using digoxin, carvedilol, bisoprolol. Precardioversion TEE was done within 24 h of cardioversion. All pts received warfarin. Heart rate on admission and after one month follow up (mean): G1: 96 then 78. G2: 95 then 74. All improvement of LV function was statistically insignificant. NIHA class II, III and IV: G1: 100% then 66%, G2: 91% then 58%. The EF increased from 41% to 46% and 42% to 47%. Fractional shortening: G1 20 to 23; G2 20 to 23. Tei index improved in both groups: 1.4 and 0.96 to 1.27 and 0.74. LA diameter G1 50 mm to 52; G2 48 to 46. Both rate and rhythm control strategies are effective in controlling HR equally. There is no difference between both strategies in improvement in LV function after one month of therapy.