Abstract

Background: Atrial fibrillation (AF) and heart failure (HF) often coexist. We investigated whether restoring sinus rhythm (SR) could improve cardiac function, symptoms, exercise capacity and quality of life (QoL) in patients with chronic heart failure.

Methods: Patients with HF and persistent AF receiving guideline-recommended treatments, including anti-coagulants, were eligible for the study. Patients were randomised to either rhythm (treated with amiodarone for at least three months prior to attempting biphasic external cardioversion and continued amiodarone long-term if SR was restored) or rate control. Anti-coagulants were continued throughout the study regardless of rhythm, unless contra-indications developed. Both groups were treated with beta blockers and/or digoxin to reduce heart rate to <80 bpm at rest and <110 bpm after walking. Symptoms, walk distance (6MWT), QoL and cardiac function were assessed at baseline and one year.

Results: 61 patients with HF and persistent AF (median duration 14 months (IQR 5 – 32)) were randomly assigned to a rate or rhythm control strategy. Of patients assigned to rhythm control (n = 30), 66% were in SR at one year and 90% of those assigned to rate control (n = 31) achieved the heart rate target. At one year, NYHA class (p=0.424) and 6MWT distance (p= 0.342) were similar between groups but patients assigned to rhythm control had improved LV function (p=0.014), NT-proBNP concentration (p=0.046) and QoL (p=0.019) compared to those assigned to rate control. Greatest improvement was seen in patients in whom SR was maintained.

Conclusion: Restoring SR in patients with AF and heart failure may improve QoL and LV function when compared to a strategy of rate control.