Impact of ventricular response irregularity in patients with atrial fibrillation and heart failure

Dronedarone is an amiodarone analog but differs structurally from amiodarone in that the iodine moiety was removed and a methane-sulfonyl group was added. These modifications reduced thyroid and other end-organ adverse effects and makes dronedarone less lipophilic, shortening its half-life. Dronedarone has been shown to prevent atrial fibrillation/flutter (AF/AFl) recurrences in several multi-center trials. In addition to its rhythm control properties, dronedarone has rate control properties and slows the ventricular response during AF. Dronedarone is approved in Europe for rhythm and rate control indications. In patients with decompensated heart failure, dronedarone treatment increased mortality and cardiovascular hospitalizations. However, when dronedarone was used in elderly high risk AF/AFl patients excluding such high risk heart failure, cardiovascular hospitalizations were significantly reduced and the drug was approved in the USA for this indication in 2009 by the Food and Drug Administration. Updated guidelines suggest dronedarone as a front-line antiarrhythmic in many patients with AF/Fl but caution that the drug should not be used in patients with advanced heart failure. In addition, the recent results of the PALLAS trial suggest that dronedarone should not be used in the long-term treatment of patients with permanent AF.

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Abstract 12957: Delay in Qrs Interval Predicts Risk of Heart Failure and In-hospital Mortality in Patients Admitted With Atrial Fibrillation With Rapid Ventricular Response

Circulation ◽

10.1161/circ.142.suppl_3.12957 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Belal Kaseer ◽

Bassman Tappuni ◽

Ali AlKhayru ◽

Awfa Zain Elabidin ◽

Vahid Namdarizandi ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Hospital Mortality ◽

Cardiac Resynchronization ◽

Hospital Death ◽

P Value ◽

Increased Risk ◽

Ventricular Response ◽

History Of ◽

Acute Mi

Introduction: Atrial fibrillation is associated with increased risk of heart failure and mortality. The association of QRS duration (QRSd) with morbidity and mortality is understudied in patient with atrial fibrillation (AF) Hypothesis: We sought to investigate the association of prolonged QRSd (≥120 ms) and risk of heart failure and in-hospital death in patients admitted for AF with rapid ventricular response (RVR) Methods: A retrospective study in a community hospital using EPIC database analyzed 1637 patients from 2013-2018 with admission codes of AF with RVR. The cohort was then stratified based on QRSd ≥120ms vs <120ms. A p-value of <0.05 was considered significant Results: Among the 1637 patients who were admitted with AF with RVR, 233 (14%) had QRS ≥120ms. Patient’s characteristics with QRSd≥120 compared to those with QRSd<120ms were mean age [75.9 (11.8) vs 70.9 (13.6), (P<.0001)], history of CAD [41% vs 28%, odds ratio (OR)= 1.78, 95% confidence interval (CI): 1.3-2.3 (P<.0001)], history of PVD [15% vs 7%, OR=2.38, 95% CI: 1.58-3.59 (P<.0001)], history of acute MI [50% vs 33%, OR=1.99, 95% CI:1.5-2.6 (P<.0001)] and CHA2DS2Vasc score [median (IQR) 5(3, 6) vs 4(3, 5) (P<0.001). QRSd≥120ms was associated with higher BNP value [median (IQR) 537(305, 862) vs 371(186, 655) (P<0.001)] and an increased risk of heart failure [(70% vs 55%, OR=1.93, 95% CI:1.43-2.6 (P<.0001)]. Additionally, higher in-hospital mortality rate was observed in patients with QRSd≥120ms [4.3% vs 1.3%, OR=3.11, 95% CI:1.44-6.75 (P=0.006)] Conclusions: In patients who were admitted with AF with RVR, QRSd≥120ms was associated with a higher burden of cardiovascular disease, CHA2DS2Vasc score and an increased risk of heart failure resulting in worse clinical outcomes. Higher median BNP values suggest that worsening heart failure contributed to higher in-hospital mortality. Heart failure associated mortality could be alleviated with medical management or cardiac resynchronization therapy.

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