Management of atrial fibrillation in the setting of heart failure

Crijns, Hjgm; Berg, van den Maarten; Gelder, van Isabelle; Veldhuisen, van Dirk

doi:10.1093/eurheartj/18.suppl_c.45

Cited by 65 publications

(57 citation statements)

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“…Moreover, class I antiarrhythmic drugs are associated with a higher incidence of adverse effects, such as proarrhythmia and conduction disturbances, and thus increase the risk of arrhythmic death or worsening heart failure. 3,5,7 In the present study, 70% of the patients were administered angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor blocker as the basic treatment of heart failure and these drugs may also be beneficial in the management of heart failure and AF through their reduction of neurohormonal activation. 1,3 Our result of 59% of patients successfully maintaining SR while on low-dose amiodarone during a mean followup of 18 months is comparable with the results of previous studies (53-79%).…”

Section: Discussionmentioning

confidence: 81%

“…3,5,7 In the present study, 70% of the patients were administered angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor blocker as the basic treatment of heart failure and these drugs may also be beneficial in the management of heart failure and AF through their reduction of neurohormonal activation. 1,3 Our result of 59% of patients successfully maintaining SR while on low-dose amiodarone during a mean followup of 18 months is comparable with the results of previous studies (53-79%). [22][23][24][25][26][27][28][29][30] However, unlike the previous studies in which recurrence increased linearly, our results are characterized by the first recurrence most often occurring within 1 year of initiating amiodarone therapy and the reasons for this difference may include: (1) a lower maintenance dose of amiodarone than previously reported (200-400 mg/day); 29 (2) symptomatic heart failure and left ventricular dysfunction in all patients in the present study; and (3) many of the present patients had nonischemic heart disease.…”

Section: Discussionmentioning

confidence: 81%

“…9 The development of AF results in worsening heart failure, causing an uncontrolled heart rate with shortened filling time and provocation of tachycardiomyopathy; absence of the atrial kick and irregular ventricular rhythm will lead to a fall in cardiac output. 3 Neurohormonal disturbance will also be induced by activation of the autonomic nervous system and renin -angiotensin system, and will in turn aggravate the heart failure and AF. 3,4 A recent report indicated that the plasma levels of atrial and brain natriuretic peptides could provide independent prognostic information of the recurrence of AF in patients with mild heart failure.…”

Section: Discussionmentioning

confidence: 99%

“…3 Neurohormonal disturbance will also be induced by activation of the autonomic nervous system and renin -angiotensin system, and will in turn aggravate the heart failure and AF. 3,4 A recent report indicated that the plasma levels of atrial and brain natriuretic peptides could provide independent prognostic information of the recurrence of AF in patients with mild heart failure. 20 There is also a risk of thromboembolism in patients with uncontrolled heart failure who develop AF.…”

Section: Discussionmentioning

confidence: 99%

“…Atrial fibrillation can lead to clinical deterioration and hospitalization for heart failure, [3][4][5] and it also increases the risk of cardiovascular morbidity among patients with a severe heart failure. 6 Therefore, the prevention or conversion of AF or flutter is important in the management of heart failure.…”

mentioning

confidence: 99%

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Effect of Low-Dose Amiodarone on Atrial Fibrillation or Flutter in Japanese Patients With Heart Failure.

Shiga

Wakaumi

Imai

et al. 2002

Circ J

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The efficacy and safety of amiodarone in the management of atrial fibrillation (AF) or flutter in 108 Japanese patients with heart failure was retrospectively examined. Thirty-four (41%) of the 82 patients who were in sinus rhythm after 1 month of amiodarone administration had their first recurrence, 70% of cases occurring within 1 year of initiation. The cumulative rates of maintenance of sinus rhythm were 0.68, 0.55, and 0.47 at 1, 3, and 5 years, respectively. Amiodarone was more effective in maintaining sinus rhythm in patients with paroxysmal AF or flutter than in those with the persistent form (p<0.05). The cumulative rates for cases that remained in permanent AF were 0.04, 0.11, and 0.14 at 1, 3, and 5 years, respectively. Apart from suppressing AF, the mean heart rate during Holter monitoring was significantly decreased with amiodarone therapy in cases of permanent AF. Adverse effects requiring the discontinuation of amiodarone therapy occurred in 16% of patients. Low-dose amiodarone therapy may prevent AF or flutter in Japanese patients with heart failure. (Circ J 2002; 66: 600 -604)

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