Prevention Of Atrial Fibrillation In Patients Research Articles

Postoperative Atrial Fibrillation Prevention in Patients Undergoing Coronary Artery Bypass Grafting by Using Perioperative HCN Channel Blockers and Selective Beta Blockers

Postoperative Atrial Fibrillation Prevention in Patients Undergoing Coronary Artery Bypass Grafting by Using Perioperative HCN Channel Blockers and Selective Beta Blockers

Drug Target Mendelian Randomization Study of PCSK9 and HMG-CoA Reductase Inhibition and Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is a prevalent cardiac arrhythmia with significant clinical implications. The potential influence of lipid-lowering therapies, specifically PCSK9 inhibitors (PCSK9i) and HMG-CoA reductase inhibitors (statins), on AF risk remains a topic of interest. This mendelian randomization (MR) study aimed to elucidate the causal relationship between genetically predicted inhibition of PCSK9 and HMG-CoA reductase and the risk of AF. Methods: Utilizing publicly available, summary-level genome-wide association study data, we employed single-nucleotide polymorphisms associated with lower LDL-C levels as instruments for gene-simulated inhibition of PCSK9 and HMG-CoA reductase. Multiple MR techniques were applied to estimate the causal effects, and sensitivity analyses were conducted to validate the results. Results: Genetically predicted inhibition of PCSK9 demonstrated a reduced risk of AF, with an odds ratio (OR) of 0.92 (95% CI: 0.85–0.99, p = 0.01) using the inverse variance-weighted (IVW) method. In contrast, the inhibition of HMG-CoA reductase did not exhibit a statistically significant association with AF risk (IVW: OR = 1.11, 95% CI: 1.00–1.22, p = 0.05). Conclusion: Our MR study suggests that genetically predicted inhibition of PCSK9, but not HMG-CoA reductase, is associated with a lower risk of AF. These findings provide evidence for a causal protective effect of PCSK9i on AF and support the use of PCSK9i for AF prevention in patients with dyslipidemia. Further studies are needed to elucidate the mechanisms underlying the differential effects of PCSK9i and statins on AF and to confirm the clinical implications of our findings.

Beta-blockers in Hypertensive Left Ventricular Hypertrophy and Atrial Fibrillation Prevention.

Hypertensive left ventricular hypertrophy (HTN LVH) is a key risk factor for atrial fibrillation (AF). To evaluate the possible role of beta-blockers (BBs) in addition to a renin-angiotensinaldosterone system (RAAS) blocker in AF prevention in patients with HTN LVH. We performed a PubMed, Elsevier, SAGE, Oxford, and Google Scholar search with the search items 'beta blocker hypertension left ventricular hypertrophy patient' from 2013-2023. In the end, a 'snowball search', based on the references of relevant papers as well as from papers that cited them was performed. HTN LVH is a risk factor for AF. In turn, AF substantially complicates HTN LVH and contributes to the genesis of heart failure (HF) with preserved ejection fraction (HFpEF). The prognosis of HFpEF is comparable with that of HF with reduced EF (HFrEF), and, regardless of the type, HF is associated with five-year mortality of 50-75%. The antiarrhythmic properties of BBs are wellrecognized, and BBs as a class of drugs are - in general - recommended to decrease the incidence of AF in HTN. BBs are recommended (as a class) for AF prevention in several contemporary guidelines for HTN. LVH regression in HTN - used as a single criterion for the choice of antihypertensive medication - does not capture this protective effect. Consequently, it is worth studying how meaningful this antiarrhythmic action (to prevent AF) of BBs is in patients with HTN LVH in addition to a RAAS blocker.

Correction of Potentially Modifiable Components of Metabolic Syndrome for the Primary Prevention of Atrial Fibrillation in Comorbid Patients with Premature Atrial Complexes

AIM: The study aimed to evaluate the influence of the correction of potentially modifiable risk factors for the development of atrial fibrillation (AF) as primary prevention of AF in patients with metabolic syndrome (MS) and premature atrial complexes (PAC).
 MATERIALS AND METHODS: We monitored 856 MS patients with PAC, aged 5872 (mean age, 66.4 0.7) years, in the north-western region of the Russian Federation. A 5-year risk of AF was calculated in all patients after the examination by determining the potential prognostic time range for Af development and its index of probable occurrence (RCHARGE-AF) using the CHARGE-AF model. The correction of potentially modifiable MS components and risk factors for AF development (smoking cessation, elimination of physical inactivity, etc.) until their target values were achieved was offered to all patients. The follow-up endpoint was the preservation of sinus rhythm or AF registration.
 RESULTS: All patients with MS were distributed into three groups. Group I consisted of 557 (65.07%) patients with incomplete correction of risk factors, and group II included 93 (10.86%) who achieved the target values of all potentially modifiable factors for AF development. The control group included the remaining patients without quantitative and qualitative changes in the dynamics AF predictors. No significant differences were found between the groups in terms of sex, age, concomitant diseases, and risk factors for AF. The achievement of the target values of the main MS components, including body mass index and/or waist circumference, correlated with the performance of regular aerobic exercises (odds ratio [OR] = 8.9), adherence to a diet (OR = 7.5), duration of MS diagnosis 20 years before the start of correction (OR = 12.8), and intake of a glucagon-like peptide-1 receptor agonist (Liraglutide) (OR = 5.4).
 In the control group, group I, and group II, AF development did not differ significantly and was registered in 192 (93.20%), 491 (88.15%), and 79 (84.95%) patients (p 0.05), respectively.
 CONCLUSIONS: In MS patients with PAC and a high 5-year risk of AF, the correction of potentially modifiable risk factors for AF development, as its primary prevention, is ineffective. The determination of the RCHARGE-AF index in MS patients with PAC in dynamics indicates the efficiency of the correction of potentially modifiable risk factors for AF development, but it does not determine the degree of the risk of its occurrence.
 The authors declare no conflict of interest.

Abstract 16187: Incidence, Risk Factors, and Outcomes of Atrial Fibrillation After Blood and/or Marrow Transplant

Introduction: Atrial fibrillation (AF) is known to occur after blood and/or marrow transplant (BMT) and has been shown to increase morbidity and mortality. Our objective was to characterize the incidence, risk factors, and clinical impact of AF in patients within the first 90 days after BMT. Methods: Patients with active malignancy undergoing BMT from 2012-2016 at the Medical College of Wisconsin were included (n=1159). Medical records were reviewed for baseline patient characteristics, AF risk factors, and clinical outcomes. Patients were categorized based on development of AF within 90 days post-BMT. Baseline characteristics and risk factors were analyzed to determine predictors for AF and all-cause mortality at 90 days. Results: Amongst the entire cohort, 5.3% of patients developed AF within the first 90 days after BMT. Significant baseline differences between those with or without AF post-BMT are outlined in Table 1. Multivariable analysis showed that a history of AF (OR: 6.7; 95% CI: 3.3-13.6; P = <0.001) and prior XRT (OR: 2.3; 95% CI: 1.2-4.6; P = 0.018) were independent predictors of developing AF. Univariate analysis demonstrated that AF was associated with 90-day mortality (HR: 7.6; 95% CI: 3.5-16.5; log rank P < 0.001). Multivariable analysis (adjusted for age, gender, race, history of XRT, BMT type, and malignancy type) revealed that female gender (HR: 2.6; 95% CI: 1.2-5.5; P = 0.016), non-Caucasian race (HR: 2.7; 95% CI: 1.1-6.4; P = 0.024) and development of AF (HR: 9.2; 95% CI: 3.7-21.5; P < 0.001) were significant independent predictors of early mortality. Conclusions: This analysis demonstrated that a prior history of AF and prior XRT were independent predictors for the development of AF in the early period post-BMT and AF is a significant independent predictor of early mortality after BMT. Further studies assessing the potential benefits of AF prevention in patients after BMT is warranted.

Sleep Apnea Increases the Risk of New Hospitalized Atrial Fibrillation: A Historical Cohort Study

This study examined the relationship between newly diagnosed OSA and incident hospitalized atrial fibrillation (AF) over the subsequent 10 years in a large arrhythmia-free cohort. Adults referred between 1994 and 2010 to a large academic hospital with suspected OSA who were arrhythmia-free at the time of the first diagnostic sleep study were included. Clinical data were linked to provincial health administrative data to define outcome. Cox regressions were used to investigate the relationship between severity of OSA as measured by the apnea-hypopnea index (AHI) and degree of nocturnal hypoxemia, and incident hospitalized AF. In total, 8,256 subjects were included in this study. Their median age was 47 years, 62%were men; 28%had an AHI > 30 events per hour, and 6%spent > 30%of sleep time with oxygen saturation< 90%. Over a median follow-up of 10 years (interquartile range, 7-13 years), 173 participants (2.1%) were hospitalized with AF. Controlling for age, sex, alcohol consumption, smoking status, previous heart failure, COPD, and pulmonary embolism, nocturnal hypoxemia (but not AHI) was a significant predictor of incident AF: hazard ratio, 2.47 (95%CI, 1.64-3.71). After further controlling for BMI and hypertension, this association was attenuated but remained significant (hazard ratio, 1.77 [95%CI, 1.15-2.74]). In a large arrhythmia-free clinical cohort with suspected OSA, nocturnal hypoxemia was independently associated with a 77%increased hazard of incident hospitalized AF. These findings further support a relationship between OSA, nocturnal hypoxemia, and new-onset AF, and they may be used to enhance AF prevention in patients with OSA and severe nocturnal hypoxemia.

Atorvastatin prevents postoperative atrial fibrillation in patients undergoing cardiac surgery

BackgroundObservational studies have suggested that statins might reduce postoperative atrial fibrillation (AF) in patients undergoing cardiac surgery. However, a number of retrospective studies have shown equivocal results. We aimed to evaluate whether different statins can reduce the risk for AF at different doses. MethodsWe searched PubMed, EMBASE, and the Cochrane Database for all published randomized controlled trials (RCTs) that examined the effects of statin therapy on AF up to June 2016. A random-effects model was used when there was substantial heterogeneity. ResultsEighteen published studies that included 4003 statin-naive patients (2009 receiving satins and 1994 receiving regime) with sinus rhythm before cardiac surgeries were identified for inclusion in the analysis. Thirteen studies investigated the prevention of AF by atorvastatin, two studies investigated the prevention of AF by rosuvastatin, two studies investigated the prevention of AF by simvastatin, and one study investigated the prevention of AF by pravastatin. The remaining two studies compared the effects of different doses of atorvastatin on the prevention of AF in patients undergoing coronary artery bypass grafting (CABG). Overall, statin therapy was associated with a significant decrease in the risk for AF (relative risk [RR]: 0.57, 95% confidence interval [CI]: 0.45–0.73, P = 0.000). However, subgroup analyses showed that only atorvastatin reduced the risk for new-onset AF in patients after cardiac surgery (RR: 0.53, 95% CI: 0.41–0.69, P = 0.000). Patients undergoing CABG possibly received more benefits from statin therapy (RR: 0.52, 95% CI: 0.39–0.68).Statin therapy in a moderate dose may be optimal (RR: 0.42, 95% CI: 0.28–0.64). ConclusionsThis meta-analysis suggests that statin therapy has an overall protective effect against postoperative AF, among which atorvastatin in a moderate dose was significantly associated with a decreased risk for new-onset AF in patients after CABG. Moreover, simvastatin may also exert a significant protective effect against the AF recurrences in patients undergoing cardiac surgeries; hence, further prospective studies are warranted.

Альтернативные методы доставки амиодарона в профилактике фибриляции предсердий у пациентов после операций аортокоронарного шунтирования

Альтернативные методы доставки амиодарона в профилактике фибриляции предсердий у пациентов после операций аортокоронарного шунтирования

Primary prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with end-stage renal disease undergoing dialysis

Current evidence suggests that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce the incidence of new atrial fibrillation (AF) in a variety of clinical conditions, including the treatment of left ventricular dysfunction or hypertension. Here we assessed whether ACEIs and ARBs could decrease incidence of new-onset AF in patients with end-stage renal disease (ESRD). We identified patients from the Registry for Catastrophic Illness, a nation-wide database encompassing almost all of the patients receiving dialysis therapy in Taiwan from 1995 to 2008. Propensity score matching and Cox proportional hazards regression models were used to estimate hazard ratios for new-onset AF. Among 113,186 patients, 13% received ACEIs, 14% received ARBs therapy, and 9% received ACEIs or ARBs alternatively. After a median follow-up of 1524 days, the incidence of new-onset AF significantly decreased in patients treated with ACEIs (hazard ratio 0.587, 95% confidence interval 0.519-0.663), ARBs (0.542, 0.461-0.637), or ACEIs/ARBs (0.793, 0.657-0.958). The prevention of new-onset AF was significantly better in patients taking longer duration of ACEI or ARB therapy. The effect remained robust in subgroup analyses. Thus both ACEIs and ARBs appear to be effective in the primary prevention of AF in patients with ESRD. Hence, renin-angiotensin system inhibition may be an emerging treatment target for the primary prevention of AF.

Ranolazine as a promising treatment option for atrial fibrillation: electrophysiologic mechanisms, experimental evidence, and clinical implications.

Currently available agents for pharmacologic management of atrial fibrillation (AF) are limited by their suboptimal efficacy and nonnegligible proarrhythmic risk. Ranolazine (RN) is a novel antianginal agent with increasingly appreciated antiarrhythmic properties that can suppress ventricular and supraventricular arrhythmias including AF. In this review, we describe the electrophysiological properties of RN, focusing on atrial-selective inhibition of a number of ion channels implicated in the development of AF, particularly the sodium current. We further summarize evidence from experimental studies that demonstrate a potent AF-suppressing effect of RN, alone or in combination with other antiarrhythmic drugs. Of clinical relevance, we present growing evidence from preliminary clinical investigations indicating the safety and efficacy of RN for prevention and treatment of AF in various clinical settings including prevention of AF in patients with acute coronary syndromes, prevention and conversion of postoperative AF after surgical coronary revascularization, sinus rhythm maintenance in drug-resistant recurrent AF, and facilitating of electrical or pharmacological cardioversion in cardioversion-resistant patients. While current experimental and clinical evidence points to RN as a potentially promising agent for suppression of AF, well-designed, large-scale trials will be required before RN can be considered for pharmacological treatment of AF in clinical practice.

Hypertension and atrial fibrillation: epidemiology, pathophysiology and therapeutic implications

Hypertension is one of the most important risk factors associated with atrial fibrillation (AF) and increased the risk of cardiovascular events in patients with AF. However, the pathophysiological link between hypertension and AF is unclear. Nevertheless, this can be explained by the hemodynamic changes of the left atrium secondary to long standing hypertension, resulting in elevated left atrium pressure and subsequently left atrial enlargement. Moreover, the activation of renin-angiotensin-aldosterone system (RAAS) activation in patients with hypertension induces left atrial fibrosis and conduction block in the left atrium, resulting in the development of AF. Accordingly, recent studies have shown that effective blockage of RAAS by angiotensin converting enzyme inhibitors or angiotensin receptor antagonist may be effective in both primary and secondary prevention of AF in patients with hypertension, although with controversies. In addition, optimal antithrombotic therapy, blood pressure control as well as rate control for AF are key to the management of patients with AF.

Statin therapy in the prevention and treatment of atrial fibrillation

Atrial fibrillation (AF) is the most common adult rhythm disorder, and it is associated with a substantial rate of morbidity and economic burden. There is an increasing body of literature in which the authors investigated the pleiotropic effects of statin therapy in relation to AF. In this comprehensive review, we examine the mechanism of AF as well as potential mechanisms supporting statin use in both the prevention and treatment of AF. In clinical studies, statin therapy appears to be useful in the prevention of AF in patients with coronary artery disease and possibly congestive heart failure and in the prevention of perioperative AF in cardiac surgery. Its utility in patients with paroxysmal AF may be limited to the prevention of incident AF, but it does not appear to inhibit the progression of paroxysmal AF to chronic AF. Further large scale, randomized, placebo-controlled studies are needed in perioperative use in noncardiac surgery and in patients undergoing ablation or cardioversion of AF.

Effect of High-dose Telmisartan on the Prevention of Recurrent Atrial Fibrillation in Hypertensive Patients.

Background: Telmisartan has been shown to exert an equivalent action as ramipril on the prevention of cardiovascular events, but the dose-dependent actions of telmisartan on the prevention of events remain unknown. Objective: We investigated the dose-dependent effects of telmisartan on the prevention of AF in patients associated with risk factors. Methods: One hundred hypertensive patients were randomized to take 40 mg (low-dose group: n=57) or 80 mg (high-dose group: n=43) of telmisartan for 24 months. The primary endpoints were defined as a new development and/or recurrence of atrial fibrillation (AF). Results: The mean values of the blood pressure in both groups decreased significantly and to similar degrees after 24 months, in the low-dose (p < 0.01) and high-dose (p < 0.01) groups. At the end of the follow-up, the incidence of AF was lower in the high-dose group than in the low-dose group (p < 0.05). Moreover, the proportion of AF recurrences in the patients with a past history of paroxysmal AF was lower in the high-dose group than in the low-dose group (p < 0.05). Further, using a logistic regression model, there were no risk factors associated with the incidence of AF. Conclusion: The results indicated that telmisartan in low doses was as effective in controlling the blood pressure as in high doses, but high doses of telmisartan had beneficial effects on preventing the recurrence of AF in hypertensive patients.

Inhibition of the Renin-Angiotensin System for Prevention of Atrial Fibrillation

Atrial fibrillation (AF) is a source of considerable morbidity and mortality. There has been compelling evidence supporting the role of renin-angiotensin system (RAS) in the genesis and perpetuation of AF through atrial remodeling, and experimental studies have validated the utilization of RAS inhibition for AF prevention. This article reviews clinical trials on the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) for the prevention of AF. Results have been variable, depending on the clinical background of treated patients. ACEIs and ARBs appear beneficial for primary prevention of AF in patients with heart failure, whereas they are not equally effective in hypertensive patients with normal left ventricular function. Furthermore, the use of ACEIs or ARBs for secondary prevention of AF has been found beneficial only after electrical cardioversion. Additional data are needed to establish the potential clinical role of renin-angiotensin inhibition for prevention of AF.

Pleiotropic effects of statins in atrial fibrillation patients: the evidence.

Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. The understanding of the pathophysiology of AF has changed during the last several decades, and a significant role of inflammation and of the renin-angiotensin-aldosterone system has been postulated both experimentally and clinically. There is emerging evidence of an association between inflammation and AF, and mounting evidence links increased C-reactive protein levels not only to already existing AF but also to the risk of developing future AF. The beneficial effects of statins on AF have been reported in several studies. Several randomized clinical and large observational studies have shown similar result that show the beneficial effect of statins in AF. In clinical studies, statins were considered effective in preventing AF after electrical cardioversion, post-ablation, and after permanent pacemaker and implantable cardioverter defibrillator insertion. The antiarrhythmic mechanisms of statins regarding AF prevention in patients with heart failure are still not clear. Perioperative statin use has been associated with favorable postoperative outcome in both cardiovascular and noncardiovascular conditions. Despite a growing body of evidence that drugs with anti-inflammatory properties such as statins may prevent AF, the observed positive effects of statins on the burden of AF appeared to be independent of their cholesterol-reducing properties. However, further data from large-scale randomized trials are clearly needed.

The rationale and design of the FORωARD Trial: A randomized, double-blind, placebo-controlled, independent study to test the efficacy of n-3 PUFA for the maintenance of normal sinus rhythm in patients with previous atrial fibrillation

Atrial fibrillation (AF) is associated with increased risk of death, thromboembolic complications, and a lowered quality of life. Despite this burden, pharmacologic agents for prevention of AF in patients who achieved normal sinus rhythm are of limited utility, mostly because of serious and frequent side effects. Thus, the availability of safer and more effective drugs may reduce the burden of disease. Patients aged > or =21 years with previous symptomatic AF and who have recovered normal sinus rhythm will be randomized to 1 g daily of omega-3-acid ethyl esters or identical placebo. To be included in the trial, patients must have either (a) at least 2 symptomatic episodes of documented AF in the 6 months before randomization, with the last episode occurring in the 14 to 90 days before randomization (paroxysmal AF), or (b) successful electrical or pharmacologic cardioversion for persistent AF. Ethical committees of 71 cardiology centers in 16 provinces of Argentina have qualified and approved the protocol and are expected to enroll 1,400 patients to test the primary end point of efficacy, which is survival free of AF during follow-up. The Fish Oil Reserach with omega-3 for Atrial fibrillation Recurrence Delay (FORomegaARD) trial will determine whether pharmacologic supplementation with 1 g of omega-3-acid ethyl esters can reduce AF recurrence in patients with previous AF who have recovered normal sinus rhythm.

Atrial Fibrillation in Heart Failure

Management of atrial tachyarrhythmias, especially atrial fibrillation (AF), in patients with congestive heart failure (CHF) remains a major challenge. It is widely recognized that CHF promotes AF and that AF worsens CHF. An individual with either condition who develops the other has higher morbidity and poorer prognosis. The prevalence of AF and CHF is expected to increase as the population ages. Therefore, it remains just as likely as it was more than a decade ago that the emerging epidemic of AF and CHF will continue to be both a challenge and an opportunity. Article p 93 Current antiarrhythmic drugs (AADs) for AF prevention in patients with CHF remain unsatisfactory, with limited efficacy and considerable potential for adverse effects. Preliminary results from a large trial examining whether a rhythm-control strategy is superior to a rate-control strategy in patients with AF and CHF do not suggest a benefit in cardiovascular mortality rate, CHF, or stroke by attempting to maintain sinus rhythm with current AAD therapy (primarily amiodarone).1 Newer nonpharmacological therapies, including pulmonary vein (PV) isolation and cardiac resynchronization therapy, are generating considerable interest; however, their rates of efficacy in patients with AF and CHF have not been established definitively. Thus, continued progress toward an enhanced understanding of upstream mechanisms that promote AF and contractile dysfunction in CHF and development of innovative therapeutic approaches based on fundamental, mechanistic insights is of paramount importance. In this context, the study by Yeh et al2 in this issue of Circulation: Arrhythmia and Electrophysiology provides important new insights into the role of atrial calcium dysregulation in promoting atrial arrhythmias and contractile dysfunction in the CHF substrate. This report comes from the Nattel laboratory, which has been a major driving force in improving our understanding of arrhythmogenic mechanisms in a variety of AF substrates, including CHF. …

Antiarrhythmic Effect of Statin Therapy and Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials

To improve the evaluation of the possible antiarrhythmic effect of statins, we performed a meta-analysis of randomized trials with statins on the end point of incidence or recurrence of atrial fibrillation (AF).The use of statins had been suggested to protect against AF in some clinical observational and experimental studies but has remained inadequately explored.A systematic review of controlled trials with statins was performed. Eligible studies had to have been randomized controlled parallel-design human trials with use of statins that collected data on incidence or recurrence of AF.Six studies with 3,557 patients in sinus rhythm were included in the analysis. Three studies investigated the use of statins in patients with a history of paroxysmal AF (n = 1) or persistent AF undergoing electrical cardioversion (n = 2), and 3 investigated the use of statins in primary prevention of AF in patients undergoing cardiac surgery or after acute coronary syndrome. Incidence or recurrence of AF occurred in 386 patients. Overall, the use of statins was significantly associated with a decreased risk of AF compared with control (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.18 to 0.85, p = 0.02). Benefit of statin therapy seemed more marked in secondary prevention of AF (OR 0.33, 95% CI 0.10 to 1.03, p = 0.06) than for new-onset or postoperative AF (OR 0.60, 95% CI 0.27 to 1.37, p = 0.23).Use of statins was significantly associated with a decreased risk of incidence or recurrence of AF in patients in sinus rhythm with a history of previous AF or undergoing cardiac surgery or after acute coronary syndrome.

Management of atrial fibrillation in patients with heart failure

Atrial fibrillation (AF) and chronic heart failure (CHF) are two major and even growing cardiovascular conditions that often coexist. However, few data are available to guide treatment of AF in patients with CHF. This review summarizes current literature concerning the following topics: (i) prognostic relevance of AF in patients with CHF, (ii) relevance and strategies of rhythm and rate control in patients with AF and CHF, and (iii) options for prevention of AF in patients with ventricular dysfunction. In conclusion, AF is associated with increased mortality in CHF patients. However, it is not clear whether there is a causal relationship. Emerging strategies to prevent the occurrence of AF are promising tools that might improve quality of life and survival in patients with CHF.

Dual site atrial pacing is effective for atrial fibrillation prevention in patients with and without atrial conduction delay Atul Prakash, Sanjeev Saksena, Ryszard Krol. CV Institute, Atlantic Health System, Passaic, NJ

Dual site atrial pacing is effective for atrial fibrillation prevention in patients with and without atrial conduction delay Atul Prakash, Sanjeev Saksena, Ryszard Krol. CV Institute, Atlantic Health System, Passaic, NJ