P421Efficacy of radiofrequency ablation and drug therapy of atrial fibrillation in patients with heart failure

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
S Seliutskii ◽  
N Savina ◽  
A Chapurnykh
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Radiofrequency Ablation ◽  
Therapy Group ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Sf 36

Abstract Objective to compare the efficacy of radiofrequency ablation (RFA) and drug therapy in patients with atrial fibrillation (AFib) and heart failure (HF) within 12-month follow-up. Materials and methods 130 patients (men-75%, average age-62.8 ± 11.8 years) with AFib and HF with left ventricular ejection fraction (LVEF)<50% were included in a prospective study. In 107 (82%) of the included patients, intermediate LVEF was detected (40-49%). At the time of inclusion, paroxysmal AFib (PaAFib) was recorded in 60 (46%) of patients and persistent AFib (PeAFib) in 70 (54%). AFib RFA was performed in 65 patients, 65 patients continued to receive optimal antiarrhythmic therapy. Prior to the intervention and after 12 months, all patients underwent transthoracic echocardiography and quality of life (QoL) assessment using the SF-36 questionnaire. Results the freedom from AFib within 12 months follow-up period was registred in 49 (75%) of patients in the RFA group and 26 (40%) in the drug therapy group. After 12 month follow-up period we revealed increase of LVEF (p < 0.001), decrease of anteroposterior size (p <0.001) and volume (p < 0.001) of left atrium (LA), improvement of mental (p = 0.008) and physical (p = 0.048) health components according to the SF-36 questionnaire in the RFA group. In the group of drug rhythm control, after 12 months there was only the improvement of mental (p = 0.006) and physical p = 0.016) health components and it was much less than in RFA group (р<0.001). Similar results were received in patients who were free from Afib within 12 months in both groups. Conclusions in patients with AFib and HF with LVEF < 50%, restoration and maintenance of sinus rhythm using RFA was accompanied by an increase in LVEF, decrease of  LA size, and an improvement of QoL. In the group of drug therapy, there was a lower freedom from AFib and there was the slight improvement only in QoL.

scholarly journals The effectiveness of radiofrequency ablation and repeated cardioversion in combination with antiarrhythmic drug therapy in maintaining stable sinus rhythm in patients with atrial fibrillation and heart failure

Kardiologiia ◽  
2020 ◽  
Vol 60 (8) ◽  
pp. 90-97
Author(s):  
S. I. Seliutskii ◽  
N. M. Savina ◽  
A. V. Chapurnykh
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Sinus Rhythm ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Sf 36 ◽  
Electrocardiogram Monitoring ◽  
Stable Sinus Rhythm

Aim To compare the efficacy of radiofrequency ablation (RFA) and antiarrhythmic therapy (AAT) in patients with atrial fibrillation (AF) and chronic heart failure (CHF) during 12-month observation.Materials and methods This prospective, nonrandomized comparative observational study included 130 patients with AF (men, 65 %; mean age, 62.8±11.8 years) and CHF with left ventricular ejection fraction (LV EF) <50 %. Paroxysmal AF was observed in 60 (46 %) patients and persistent AF was observed in 70 (54 %) patients. According to results of transthoracic echocardiography (EchoCG) 107 (82 %) patients had intermediate LV EF (40–49 %) and 23 (18 %) patients had reduced LV EF (<40 %). RFA of AF was performed for 65 patients whereas 65 patients received an optimal AAT. The 24-h electrocardiogram monitoring, EchoCG, and assessment of the quality of life (QoL) with the SF-36 questionnaire were performed for all patients on admission and at 12 months of observation. Stability of sinus rhythm, EchoCG, QoL, and exercise tolerance were evaluated at 12 months of observation.Results 49 (75%) of patients in the RFA group and 26 (40%) of patients in the AAT group had stable sinus rhythm (SR) at 12 months. Repeated RFA for relapse of AF was performed for 6 (12 %) of 49 patients; repeated cardioversion was performed for 16 (61.5 %) of 26 patients. In the AAT group, there were more interventions for maintaining SR than in the RFA group (p<0.001). In patients with SR of the RFA group at 12 months of observation, LV EF was increased (р<0.001), left ventricular dimension (р<0.001) and volume (р<0.001) were decreased, and mental (р<0.001) and physical (p<0.001) components of health were improved according to the SF-36 questionnaire. In patients with SR of the AAT group, only improvement of mental (р<0.001) and physical (р<0.001) components of health was observed according to the SF-36 questionnaire.Conclusion RFA provided a considerable decrease in the frequency of AF relapse and improvement of LV EF in patients with CHF. The effectiveness of RFA did not depend on the type of arrhythmia. For 12 months of observation, the number of hospitalizations for decompensated CHF and interventions to maintain SR decreased in the RFA group compared to the AAT group.

scholarly journals Bucindolol Decreases Atrial Fibrillation Burden in Patients with Heart Failure and the ADRB1 Arg389Arg Genotype

2021 ◽  
Author(s):  
Jonathan P. Piccini ◽  
Christopher Dufton ◽  
Ian A. Carroll ◽  
Jeff S. Healey ◽  
William T. Abraham ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Sinus

Background - Bucindolol is a genetically targeted β-blocker/mild vasodilator with the unique pharmacologic properties of sympatholysis and ADRB1 Arg389 receptor inverse agonism. In the GENETIC-AF trial conducted in a genetically defined heart failure (HF) population at high risk for recurrent atrial fibrillation (AF), similar results were observed for bucindolol and metoprolol succinate for the primary endpoint of time to first atrial fibrillation (AF) event; however, AF burden and other rhythm control measures were not analyzed. Methods - The prevalence of ECGs in normal sinus rhythm, AF interventions for rhythm control (cardioversion, ablation and antiarrhythmic drugs), and biomarkers were evaluated in the overall population entering efficacy follow-up (N=257). AF burden was evaluated for 24 weeks in the device substudy (N=67). Results - In 257 patients with HF the mean age was 65.6 ± 10.0 years, 18% were female, mean left ventricular ejection fraction (LVEF) was 36%, and 51% had persistent AF. Cumulative 24-week AF burden was 24.4% (95% CI: 18.5, 30.2) for bucindolol and 36.7% (95% CI: 30.0, 43.5) for metoprolol (33% reduction, p < 0.001). Daily AF burden at the end of follow-up was 15.1% (95% CI: 3.2, 27.0) for bucindolol and 34.7% (95% CI: 17.9, 51.2) for metoprolol (55% reduction, p < 0.001). For the metoprolol and bucindolol respective groups the prevalence of ECGs in normal sinus rhythm was 4.20 and 3.03 events per patient (39% increase in the bucindolol group, p < 0.001), while the rate of AF interventions was 0.56 and 0.82 events per patient (32% reduction for bucindolol, p = 0.011). Reductions in plasma norepinephrine (p = 0.038) and NT-proBNP (p = 0.009) were also observed with bucindolol compared to metoprolol. Conclusions - Compared with metoprolol, bucindolol reduced AF burden, improved maintenance of sinus rhythm, and lowered the need for additional rhythm control interventions in patients with HF and the ADRB1 Arg389Arg genotype.

Abstract 17223: Castle of Stone or Straw, Radiofrequency Ablation of Atrial Fibrillation in Heart Failure?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Brian D McCauley ◽  
Esseim Sharma ◽  
John Dudley ◽  
Antony Chu
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Prospective Trials

Introduction: Based on the data from CASTLE-AF trial, in patient with Atrial Fibrillation (AF) and heart failure (HF) catheter ablation may offer a significant reduction in both death, and hospitalization, while promoting maintenance of sinus rhythm as well as improvement in left ventricular ejection fraction (LVEF). This multi-center randomized trial is hailed as a paradigm shifting study in catheter ablation, however it is not without fault. One of the critiques of the CASTLE-AF trial was the high frequency of crossover between the treatment arms. To help sort out this potential source of confounding, we performed a systematic meta-analysis of prospective trials for catheter ablation in AF in patients with Class II through IV heart failure. Hypothesis: The reduction in death, and hospitalization, as well as the maintenance in sinus rhythm and improvement in LVEF seen CASTLE-AF trial are support by other similarly designed AF ablation trials. Methods: Using the inclusion/exclusion criteria from the CASTLE-AF trial, we performed a systematic meta-analysis of 28 published studies. Randomized and non-randomized observational studies comparing the impact of catheter ablation of AF in HF. Studies were identified using the Cochrane Library, EMBASE, and PubMed. Results: A total of 29 studies were identified (n =2,339). Mean follow-up was 25 (95% confidence interval, 18-40) months. Efficacy in maintaining sinus rhythm at follow-up end was 60% (43%-76%). Left ventricular ejection fraction improved significantly during follow-up by 15% (P<0.001). Conclusions: Following our meta-analysis, we found data to support the findings of improved LVEF and maintenance of sinus rhythm reported in the CASTLE-AF trial. However, due to differences in study design, we were unable to further validate the reduction in both hospitalization and death seen in CASTLE-AF. We recommend future prospective trials be conducted without cross over to further explore this topic.

scholarly journals PREDICTORS OF ATRIAL FIBRILLATION RECURRENCE AFTER RADIOFREQUENCY ABLATION IN PATIENTS WITH CHRONIC HEART FAILURE

2021 ◽  
Vol 74 (8) ◽  
pp. 1850-1855
Author(s):  
Tetiana V. Zolotarova ◽  
Mariia S. Brynza ◽  
Dmytro Y. Volkov ◽  
Maryna I. Shevchuk ◽  
Oleksandr V. Bilchenko
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Chronic Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Atrial Fibrillation Recurrence ◽  
Ventricular Ejection Fraction ◽  
Recurrence Group ◽  
Af Recurrence

The aim: To study the predictive power of demographic, hemodynamic and electrocardiographic factors for atrial fibrillation recurrence after radiofrequency ablation (RFA) in patients with chronic heart failure. Materials and methods: Study included 120 patients, aged 59,80±10,08 years old with chronic heart failure with preserved left ventricular ejection fraction who were undergo RFA due to atrial fibrillation (AF). A standard 12-lead electrocardiogram (ECG) was registered. Before the procedure the standard echocardiographic parameters were obtained. After 12 months, patients were divided into 2 groups: non-recurrence group and recurrence group. Results: As a result of prospective follow-up within 12 months AF recurrences were observed in 32 patients (27%), 88 patients remained non-recurrent (73%). The left atrium (LA) diameter and aortic root diameter were lager in the recurrence group (4,59±0,45 vs. 4,08±0,61 cm, p<0,001; 3,37±0,60 vs. 2,80±0,67 cm, p<0,001). The AF recurrence group before RFA had a significantly longer QTc interval than the non-recurrence group (387,23±2,31 vs. 341,22±8,91 ms, p<0,010). ROC curve analysis revealed LA diameter the most sensitive factor for AF recurrence after RFA. Conclusions: QTc duration before radiofrequency ablation and its prolongation after intervention are independent predictors of atrial fibrillation recurrence; left atrium diameter before ablation is a highly sensitive predictor in patients with chronic heart failure with preserved left ventricular ejection fraction.

scholarly journals Radiofrequency Ablation Impact on the Morpho-Functional State of the Heart in Patients with Atrial Fibrillation and Chronic Heart Failure

2021 ◽  
Vol 6 (5) ◽  
pp. 169-177
Author(s):  
T. V. Zolotarova ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Functional State ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

The purpose of the study was to evaluate the radiofrequency ablation impact on the morpho-functional state of the heart in patients with atrial fibrillation and chronic heart failure with preserved ejection fraction based on 2-year follow-up. Materials and methods. The study included 194 patients with an average age of 59.3±8.5 years with atrial fibrillation and concomitant heart failure with preserved left ventricular ejection fraction of I-III functional class of New York Heart Association. Patients were divided into 2 groups: 136 patients who underwent radiofrequency catheter ablation and 58 patients in the control group who did not undergo intervention and continued antiarrhythmic pharmacotherapy. Patients were comparable in terms of basic clinical and demographic indicators. In order to assess the morpho-functional state of the heart, transthoracic echocardiography was performed at the stage of inclusion in the study and 2 years after. Results and discussion. According to the results of the analysis in the radiofrequency catheter ablation group 2 years after the intervention revealed: a statistically significant decrease in the mean end-systolic diameter of the left ventricle (3.3±0.48 cm versus 3.2±0.41cm, p <0.001); decreased size of the left atrium (4.3±0.71 cm versus 4.2±0.30 cm, p <0.001); left ventricular ejection fraction increased significantly (61.9±7.14% versus 63.9±5.65%, p <0.001); the E/e' ratio decreased statistically significantly (11.9±1.65 versus 9.4±1.48; p <0.001) and the left ventricular myocardial mass index (118.3±25.04 g/m2 versus 116.4±18.04 g/m2; p=0.045). In the pharmacotherapy group there were: a statistically significant increase in the average end-systolic size of the left ventricle (3.61±0.45 cm versus 3.63±0.41, p=0.007); statistically significant increased left atrium (4.3±0.61 cm versus 4.4±0.36; p <0.001) and the right atrium (4.1±0.52 cm versus 4.2±0.26; p <0.001); decreased left ventricular ejection fraction (58.1±6.12% versus 56.6±6.11; p <0.001); increased values of the ratio E/e' (12.1±1.63 versus 12.7±1.27; p=0.002) and decreased level of the left ventricular myocardial mass index (120.5±24.05 g/m2 versus 118.3±20.13 g/m2; p=0.044). Conclusion. Radiofrequency ablation of atrial fibrillation in patients with heart failure with preserved left ventricular ejection fraction to control sinus rhythm is associated with improved morpho-functional state of the heart at the 2-year follow-up compared with antiarrhythmic pharmacotherapy strategy: the left ventricular ejection fraction increases, the left ventricular diastolic function improves according to the E/e' value, the size of the left atrium decreases

P1491Cardiac contractility modulation in patients with chronic heart failure and atrial fibrillation: 6 months of follow-up

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
O Sapelnikov ◽  
T M Uskach ◽  
D I Cherkashin ◽  
I R Grishin ◽  
D F Ardus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Nyha Class ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Walk Test ◽  
Ventricular Ejection Fraction

Abstract Background Heart failure is developed in 30% of patients with atrial fibrillation (AF). It significantly worsens the prognosis and evaluates the fatal risks for patients. Cardiac Contractility Modulation (CCM) is a new therapeutic device for heart failure, which is used in patients with narrow QRS complexes who are refractory to medical therapy.  Purpose The aim of current study is to demonstrate the effects of CCM on patients with heart failure and AF, influencing on NT-proBNP dynamics and 6 min walk test (6-MWT).  Methods Fourty patients (40) with symptomatic heart failure (II-III NYHA class), persistent/paroxysmal AF and reduced left ventricular ejection fraction (LVEF ≤ 40%) were included. The average age was 60 ± 6 years. MeanLA-volume was 120± 22 ml and NT-proBNP level was 1336 ± 278pg/ml.A 6-MWT was 246 ± 33 m. All patients were implanted with a CCM Optimizer according to the protocol of implantation without an atrial lead. The study compared the mean state changes from baseline to 6 months’ follow-up. Results In 6 months’ follow-up we observed a significant improvement in functional and symptomatic parameters. NT-proBNP level was 1021 ± 153 pg/ml and mean 6 MWT values were 300 ± 26 m. NYHA improved by at least 1 functional class. MeanLA-volume after 6 months of follow-up was 104,5± 18 ml. Conclusions CCM is an effective and safe technology for patients with symptomatic HF. It significantly improves functional parameters, including a 6-minute walk test and NYHA functional class. CCM may prevent HF progression and may influence the outcome.

scholarly journals Effect of catheter ablation on clinical outcomes in patients with atrial fibrillation and significant functional mitral regurgitation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jin-Tao Wu ◽  
Dan-Qing Zhao ◽  
Fu-Tao Zhang ◽  
Xiao-Jie Liu ◽  
Juan Hu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Catheter Ablation ◽  
Left Ventricular Ejection Fraction ◽  
Cardiac Remodeling ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Ventricular Ejection Fraction

Abstract Background In patients with atrial fibrillation (AF) and functional mitral regurgitation (MR), catheter ablation reduces the severity of MR and improves cardiac remodeling. However, its effects on prognosis are uncertain. Methods This retrospective study included 151 consecutive patients with AF and functional MR, 82 (54.3%) of whom were treated by catheter ablation (Ablation group) and 69 (45.7%) with drug therapy without ablation (Non-ablation group). Forty-three pairs of these patients were propensity matched on the basis of age, CHA2DS2-VASc scores, and left ventricular ejection fraction. The primary outcome evaluated was severity of MR, cardiac remodeling and the combined incidence of subsequent heart failure-related hospitalization and strokes/transient ischemic attacks. Results Patients in the Ablation group showed a significant decrease in the severity of MR (p < 0.001), a significant decrease in the left atrial diameter (p = 0.010), and significant improvement in the left ventricular ejection fraction (p = 0.015). However, patients in the Non-ablation group showed only a significant decrease in the severity of MR (p = 0.004). The annual incidence of the studied events was 4.9% in the Ablation group and 16.7% in the Non-ablation group, the incidence being significantly lower in the ablation than Non-ablation group (p = 0.026) according to Kaplan–Meier curve analyses. According to multivariate Cox regression analysis, catheter ablation therapy (hazard ratio [HR] 0.27, 95% confidence interval [CI] 0.09–0.84; p = 0.024) and heart failure at baseline (HR 3.84, 95% CI 1.07–13.74; p = 0.038) were independent predictors of the incidence of the studied events. Conclusions Among patients with AF and functional MR, catheter ablation was associated with a significantly lower combined risk of heart failure-related hospitalization and stroke than in a matched cohort of patients receiving drug therapy alone.

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

scholarly journals The relationship between diastolic blood pressure and the risk of cardiovascular events in patients with atrial fibrillation: the Fushimi AF registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Ikeda ◽  
M Iguchi ◽  
H Ogawa ◽  
Y Aono ◽  
K Doi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
The Impact

Abstract Background Hypertension is one of the major risk factors of cardiovascular events in patients with atrial fibrillation (AF). However, relationship between diastolic blood pressure (DBP) and cardiovascular events in AF patients remains unclear. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in Japan. Follow-up data were available in 4,466 patients, and 4,429 patients with available data of DBP were examined. We divided the patients into three groups; G1 (DBP&lt;70 mmHg, n=1,946), G2 (70≤DBP&lt;80, n=1,321) and G3 (80≤DBP, n=1,162), and compared the clinical background and outcomes between groups. Results The proportion of female was grater in G1 group, and the patients in G1 group were older and had higher prevalence of heart failure (HF), diabetes mellitus (DM), chronic kidney disease (CKD). Prescription of beta blockers was higher in G1 group, but that of renin-angiotensin system-inhibitors and calcium channel blocker was comparable. During the median follow-up of 1,589 days, in Kaplan-Meier analysis, the incidence rates of cardiovascular events (composite of cardiac death, ischemic stroke and systemic embolism, major bleeding and HF hospitalization during follow up) were higher in G1 group and G3 group than G2 group (Figure 1). When we divided the patients based on the systolic blood pressure (SBP) at baseline (≥130 mmHg or &lt;130 mmHg), the incidence of rates of cardiovascular events were comparable among groups. Multivariate Cox proportional hazards regression analysis including female gender, age (≥75 years), higher SBP (≥130 mmHg), DM, pre-existing HF, CKD, low left ventricular ejection fraction (&lt;40%) and DBP (G1, G2, G3) revealed that DBP was an independent determinant of cardiovascular events (G1 group vs. G2 group; hazard ratio (HR): 1.40, 95% confidence intervals (CI): 1.19–1.64, G3 group vs. G2 group; HR: 1.23, 95% CI: 1.01–1.49). When we examined the impact of DBP according to 10 mmHg increment, patients with very low DBP (&lt;60 mmHg) (HR: 1.50,95% CI:1.24–1.80) and very high DBP (≥90 mmHg) (HR: 1.51,95% CI:1.15–1.98) had higher incidence of cardiovascular events than patients with DBP of 70–79 mmHg (Figure 2). However, when we examined the impact of SBP according to 20 mmHg increment, SBP at baseline was not associated with the incidence of cardiovascular events (Figure 3). Conclusion In Japanese patients with AF, DBP exhibited J curve association with higher incidence of cardiovascular events. Funding Acknowledgement Type of funding source: None

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