English

Abstract

Introduction: Atrial fibrillation (AF) and wider QRS duration have long beenidentified to worsen heart failure and LV dysfunction and increase cardiovascular morbidityand mortality. Therefore, it is necessary to identify those patients of heart failure who are atgreater risk for cardiovascular morbidity and mortality so that such subjects may be focusedfor preventive strategies. An association exists between QRS duration and AF with greaterincidences of cardiovascular events in patients of heart failure with LV systolic dysfunction.Study Design: Cross sectional survey. Setting: Department of Cardiology, Punjab Institute ofCardiology Lahore. Period: 16-02-2015 to 15-08-2015. Material and Methods: The objectiveof study was to determine the Frequency of QRS Duration groups and Atrial Fibrillation inPatients with Left Ventricular Dysfunction. Sample size of 400 cases was calculated with 95%confidence level, 4% margin of error and taking expected percentage of atrial fibrillation innarrow QRS group i.e. 20.9% (least among all) in patients with left ventricular dysfunction.Sampling technique was non-probability, purposive sampling. Result: The study populationconsisted of male (72.3%) and female (27.7%). Mean LA diameter was 40.3±6.08 mm andmean LV ejection fraction 31.8±6.6 % in the study population. Ischemic heart disease wasthe most common cause of LV dysfunction (88.3%) followed by non-ischemic cardiomyopathy(8.75%) and non-Ischemic valvular heart disease (3.5%). The frequency of Narrow QRSd (<120ms) was 62%, Intermediate QRSd (120-150 ms) was 26.5% and Wide QRSd (>150 ms) was11.5%. The frequency of atrial fibrillation in study population was 15.75%. The frequency of atrialfibrillation was highest in Wide QRSd group (>150 ms) i.e. (60.9%), followed by IntermediateQRSd group (120-150 ms) i.e. (18.9%) and narrow QRSd group (<120 ms) i.e. (6.04%). Patientwith atrial fibrillation were more likely to have poor ejection fraction (P<0.0023) and wider QRSduration (P<0.0001). Frequency of atrial fibrillation was highest in Valvular Cardiomyopathy(non-ischemic valvular heart disease) patients (42.8%) as compared to coronary artery diseasegroup (15.3%) and non-ischemic cardimyopathy group (9.4%). Conclusion: In patients of heartfailure with reduced ejection fraction (HFrEF), the frequency of atrial fibrillation increases asQRS duration widens. This group of patients must be focused for AF preventive strategies.