Title: Substrate for development of atrial fibrillation in patients with congestive heart failure: Are we close to the answer?
Abstract: Development of atrial fibrillation (AF) in patients with congestive heart failure (CHF) remains one of the leading causes of clinical deterioration. 1 Hunt S.A. Abraham W.T. Chin M.H. et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2005; 112: e154-e235 Crossref PubMed Google Scholar Approximately 15% to 20% of patients with CHF have AF, which is more common in patients with advanced cardiac disease and reaches 50% in patients with grade IV CHF according to the New York Heart Association. 2 The CONSENSUS trial study groupEffects of enalapril on mortality in severe congestive heart failure Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSU0S). N Engl J Med. 1987; 316: 1429-1435 Crossref PubMed Scopus (4690) Google Scholar According to data from controlled clinical trials, the annual incidence of AF in patients with CHF ranges from 3% to 5%. 3 Zareba W. Steinberg J.S. McNitt S. et al. Implantable cardioverter-defibrillator therapy and risk of congestive heart failure or death in MADIT II patients with atrial fibrillation. Heart Rhythm. 2006; 3: 631-637 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar , 4 Singh S.N. Poole J. Anderson J. et al. Role of amiodarone or implantable cardioverter/defibrillator in patients with atrial fibrillation and heart failure. Am Heart J. 2006; 152: 974.e7-974.e11 Scopus (25) Google Scholar , 5 Swedberg K. Olsson L.G. Charlesworth A. et al. Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET. Eur Heart J. 2005; 26: 1303-1308 Crossref PubMed Scopus (245) Google Scholar , 6 Bunch T.J. Day J.D. Olshansky B. et al. Newly detected atrial fibrillation in patients with an implantable cardioverter-defibrillator is a strong risk marker of increased mortality. Heart Rhythm. 2009; 6: 2-8 Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar Although analyses of the impact of AF on mortality in CHF trials show conflicting findings, new-onset AF during follow-up has consistently been associated with a poor prognosis and a greater than twofold increase in all-cause mortality. 3 Zareba W. Steinberg J.S. McNitt S. et al. Implantable cardioverter-defibrillator therapy and risk of congestive heart failure or death in MADIT II patients with atrial fibrillation. Heart Rhythm. 2006; 3: 631-637 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar , 5 Swedberg K. Olsson L.G. Charlesworth A. et al. Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET. Eur Heart J. 2005; 26: 1303-1308 Crossref PubMed Scopus (245) Google Scholar , 6 Bunch T.J. Day J.D. Olshansky B. et al. Newly detected atrial fibrillation in patients with an implantable cardioverter-defibrillator is a strong risk marker of increased mortality. Heart Rhythm. 2009; 6: 2-8 Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar