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(Circulation. 2004;109:e11.)
© 2004 American Heart Association, Inc.

Correspondence

Prognosis of Atrial Fibrillation in Congestive Heart Failure

Johan R. Folkeringa, MD; H.J.G.M. Crijns, MD, PhD

Department of Cardiology, University Hospital, Maastricht, the Netherlands, rfol{at}cardio.azm.nl

D.J. Van Veldhuisen, MD, PhD

Department of Cardiology, Thoraxcenter, University Hospital, Groningen, the Netherlands

To the Editor:

In a recent issue of Circulation, Wang et al¹ report that incident atrial fibrillation in patients with congestive heart failure carries a poor prognosis. They rightfully argue that early intervention to prevent atrial fibrillation in heart failure patients and to prevent congestive heart failure in patients with atrial fibrillation may importantly improve prognosis in patients suffering from one of these conditions. Previously, in a population with advanced heart failure, we did not find a decreased survival associated with incident atrial fibrillation.² This suggests that if patients suffer from advanced heart failure without previous atrial fibrillation, strategies aiming at prevention of the arrhythmia may not benefit any survival.

How to reconcile these facts? In patients surviving until an advanced stage of heart failure without previous atrial fibrillation, the very onset of atrial fibrillation cannot change the lethal effect of heart failure. This view is supported by the present Framingham analysis indicating that previous or concurrent atrial fibrillation in heart failure subjects does not have an impact on prognosis. We feel these are important observations. The advice to initiate antiarrhythmic strategies in heart failure subjects still in sinus rhythm probably only applies to those with mild to moderate forms of the disease. In this respect, the study by Vermes et al,³ in the same issue of Circulation, is promising, because it shows that preventing incident atrial fibrillation is feasible.

Hopefully, the Atrial Fibrillation and Congestive Heart Failure trial⁴ will shed light on the question of which heart failure patients will benefit from primary arrhythmia prophylaxis. Such knowledge may help to avoid needless, inconvenient, and potentially hazardous antiarrhythmic treatment in many patients with heart failure.

References

1. Wang TJ, Larson MG, Levy D, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality. The Framingham Heart Study. Circulation. 2003; 107: 2920–2925.[Abstract/Free Full Text]

2. Crijns HJ, Tjeerdsma G, de Kam PJ, et al. Prognostic value of the presence and development of atrial fibrillation in patients with advanced chronic heart failure. Eur Heart J. 2000; 21: 1238–1245.[Abstract/Free Full Text]

3. Vermes E, Tardif JC, Bourassa MG, et al. Enalapril decreases the incidence of atrial fibrillation in patients with left ventricular dysfunction: insight from the Studies Of Left Ventricular Dysfunction (SOLVD) trials. Circulation. 2003; 107: 2926–2931.[Abstract/Free Full Text]

4. The AF-CHF Investigators. Rationale and design of a study assessing treatment strategies of atrial fibrillation in patients with heart failure: the Atrial Fibrillation and Congestive Heart Failure (AF-CHF) trial. Am Heart J. 2002; 144: 597–607.[Medline] [Order article via Infotrieve]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Folkeringa, J. R. Articles by Van Veldhuisen, D.J. Search for Related Content PubMed PubMed Citation Articles by Folkeringa, J. R. Articles by Van Veldhuisen, D.J. Pubmed/NCBI databases Medline Plus Health Information Atrial Fibrillation Heart Failure