Atrial Fibrillation With Controlled Ventricular Rate and New-Onset Heart Failure: Atypical Presentation, Worse Prognosis

Document Type

Article

Publication Date

11-2022

Publisher

CardioFront LLC

Source Publication

Journal of Atrial Fibrillation & Electrophysiology (JAFIB-EP)

Source ISSN

1941-6911

Abstract

Background: There is deficient literature comparing patients with atrial fibrillation (AF) who present with rapid ventricular rate (RVR) versus controlled ventricular rate (CVR) associated with new-onset heart failure.

Purpose: This study aimed to evaluate patients with new-onset cardiomyopathy (CM) and a concomitant or preceding history of AF and compare patients with CVR (≤100 bpm) to those with RVR (>100 bpm).

Methods: Patients with newly diagnosed CM, defined as a left ventricular ejection fraction ≤40%, were identified from our healthcare database and divided into two groups: those with a ventricular rate ≤100 bpm (CVR-CM, n=79) and those with a ventricular rate >100 bpm (RVR-CM, n=117).

Results: In the CVR-CM group, 48.1% of patients presented with atypical and vague complaints compared to 25.6% (p=0.0012) in the RVR-CM group. CVR-CM patients rarely complained of typical symptoms of palpitations (5.1%). The incidents of low voltage on surface electrocardiography (EKG; 50.6% vs 31%, p=-.0213) and QRS widening (31.7% vs 15.4%, p0.007) was greater in the CVR-CM group. History of coronary artery disease (41.8% vs 28.2%, p=0.048), history of percutaneous coronary intervention (27.9% vs 12%, p=0.049), and male sex (70.9%) were more common in the CVR-CM group. Mortality was worse in patients with CVR-CM (38% vs 29%, p=0.048), but those who underwent rhythm control either by cardioversion or ablation had a much better prognosis.

Conclusion: There are significant differences in clinical presentation, EKG characteristics, history of coronary artery disease, and outcomes between patients who present with new-onset CM and CVR and new-onset CM and RVR.

Comments

Journal of Atrial Fibrillation & Electrophysiology (JAFIB-EP), Vol. 15, No. 6 (November 2022): 6-13. Publisher link.

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