Author + information
- Liu Shangyu,
- Jiarui Mi,
- Shengwen Yang,
- Wei Hua,
- Shu Zhang and
- Zhimin Liu
To assess the effect of atrial fibrillation (AF) on long-term clinical outcomes in patients receiving cardiac resynchronization therapy (CRT).
A total of 258 consecutive single-center patients with CRT between January 2010 and December 2014 were retrospectively enrolled. After undergoing median 22-months follow-up, re-hospitalization due to worsening heart failure (HF) or all-cause mortality (including heart transplantation) was analyzed using Kaplan-Meier and log-rank test curves. AF was evaluated in Cox proportional-hazards regression models as an independent prognostic factor.
vThere were 42 (16.3%) patients with AF which were older, higher proportion of men, left bundle branch block (LBBB) and prescribed with amiodarone, and had higher endogenous creatinine clearance rate, serum creatinine, serum uric acid, big endothelin-1, left ventricular end diastolic diameter. After the follow-up, 33 (12.8%) patients died, 5 (1.9%) underwent heart transplantation and 72 (27.9%) had at least one HF readmission. Log-rank test analyses demonstrated that AF was associated with a significantly higher HF re-hospitalization (χ2 = 6.651, p = 0.010) but had no effect on all-cause mortality (χ2 = 0.528, p = 0.468). Cox univariate analysis showed that AF, LBBB, serum creatinine, big endothelin-1 and left ventricular end diastolic diameter were risk factors for HF re-hospitalization; serum creatinine, big endothelin-1 and left ventricular end diastolic diameter were risk factors for all-cause mortality. Cox multivariate analysis showed that AF was not an independent risk factor for HF re-hospitalization and all-cause mortality; while the left ventricular end diastolic diameter (hazard ratio [HR]: 1.041, 95% confidence interval [CI]:1.007-1.075, p = 0.018) was the independent risk factor for HF re-hospitalization, left ventricular end diastolic diameter (HR: 1.045, 95% CI:1.001-1.091, p = 0.048) and serum creatinine (HR: 1.008, 95% CI:1.001-1.015, p = 0.035) were the independent risk factors for all-cause mortality.
In CRT patients, although AF was associated with higher HF re-hospitalization, it was not the independent risk factor for HF re-hospitalization and all-cause mortality.