Maintenance of Sinus Rhythm and Survival in Patients With Heart Failure and Atrial Fibrillation

Objectives The goal of this study was to evaluate the relationship between the presence of sinus rhythm and outcomes in patients with a history of congestive heart failure (CHF) and atrial fibrillation (AF). Background The value of sinus rhythm maintenance in patients with AF and heart failure (HF) is uncertain. Methods A total of 1,376 patients with AF, ejection fraction <= 35%, and heart failure symptoms were randomized to a rhythm-or rate-control strategy. Detailed efficacy analyses were used to evaluate the independent effects of treatment strategy and the presence of sinus rhythm on cardiovascular outcomes. Results Overall, 445 (32%) patients died and 402 (29%) experienced worsening HF. The rhythm-control strategy was not predictive of cardiovascular mortality (hazard ratio [HR]: 0.90, 95% confidence interval [CI]: 0.70 to 1.16; p = 0.41), all-cause death (HR: 0.86, 95% CI: 0.69 to 1.08; p = 0.19), or worsening HF (HR: 0.86, 95% CI: 0.68 to 1.10; p = 0.23). In analyses devised to isolate the effect of underlying rhythm, sinus rhythm was not associated with cardiovascular mortality [HR: 1.22, 95% CI: 0.80 to 1.87; p = 0.35), total mortality [HR: 1.11, 95% CI: 0.78 to 1.58; p = 0.57), or worsening HF [HR: 0.62, 95% CI: 0.37 to 1.02; p = 0.059). Conclusions A rhythm-control strategy or the presence of sinus rhythm are not associated with better outcomes in patients with AF and CHF. (J Am Coll Cardiol 2010; 55: 1796-802) (C) 2010 by the American College of Cardiology Foundation