The presence of atrial fibrillation in patients with asymptomatic and symptomatic left ventricular systolic dysfunction is associated with an increased risk for all-cause mortality, largely explained by an increased risk for pump-failure death. These data suggest that atrial fibrillation is associated with progression of left ventricular systolic dysfunction.

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60 years) & baseline LVEFs (42% vs. 43%). Randomized subjects were more likely to have prominent heart failure symptoms (6% vs. 2%) & be female (22% vs. 11%). Of the 18 deaths in follow-up, 16 occurred in the Randomized group. The odds of death in Randomized subjects was 9.6 (95% confidence interval 2.8 to 32.5) fold higher vs. Registry subjects (p ¼ 0.0004). CONCLUSION: The presence of both abnormal cardiac depolarization & impaired autonomic tone in post-MI patients with better-preserved LV function identifies a group with a nearly 10-fold higher risk of death. The REFINE ICD study is testing whether ICD therapy can alter that risk.

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