Clinical Research in Cardiology

, Volume 101, Issue 10, pp 829–836

Adverse effects of permanent atrial fibrillation on heart failure in patients with preserved left ventricular function and chronic right apical pacing for complete heart block

Authors

  • Brigitte Lampe
    • Department of CardiologyUniversity of Bonn
  • Christoph Hammerstingl
    • Department of CardiologyUniversity of Bonn
  • Jörg Otto Schwab
    • Department of CardiologyUniversity of Bonn
  • Fritz Mellert
    • Department of Cardiac SurgeryUniversity of Bonn
  • Birgit Stoffel-Wagner
    • Department of Clinical Chemistry and Clinical PharmacologyUniversity of Bonn
  • Andreas Grigull
    • Department of Clinical Chemistry and Clinical PharmacologyUniversity of Bonn
  • Rolf Fimmers
    • Department of Statistics and Medical BiometryUniversity of Bonn
  • Bernhard Maisch
    • Department of CardiologyPhilipps Universität
  • Georg Nickenig
    • Department of CardiologyUniversity of Bonn
  • Thorsten Lewalter
    • Department of CardiologyUniversity of Bonn
    • Department of CardiologyUniversity of Bonn
    • Medizinische Klinik und Poliklinik IIUniversitätsklinikum Bonn
Original Paper

DOI: 10.1007/s00392-012-0468-7

Cite this article as:
Lampe, B., Hammerstingl, C., Schwab, J.O. et al. Clin Res Cardiol (2012) 101: 829. doi:10.1007/s00392-012-0468-7

Abstract

Background

The impact of atrial fibrillation (AF) on heart failure (HF) was evaluated in patients with preserved left ventricular (LV) function and long-term right ventricular (RV) pacing for complete heart block.

Methods

Clinical, echocardiographic, and laboratory parameters of HF were assessed in 35 patients with established AF who had undergone ablation of the atrioventricular node and pacemaker implantation (Group A) and 31 patients who received dual-chamber pacing for spontaneous complete heart block (Group B).

Results

During a follow-up period of 12.7 ± 7.5 years, New York Heart Association (NYHA) functional class increased from 1.3 ± 0.5 to 2.1 ± 0.6 (p < 0.0001) in Group A, and from 1.3 ± 0.4 to 1.6 ± 0.7 (p < 0.01) in Group B. Left ventricular ejection fraction (LVEF) decreased from 59.7 ± 5.1 to 53.0 ± 8.2 (p < 0.0001) in Group A, but remained stable (58.6 ± 4.2 vs. 56.9 ± 7.0 %, p = 0,21) in Group B. At the end of follow-up, markers of LV function were moderately depressed in Group A compared with those in Group B: NYHA class 2.1 ± 0.6 versus 1.6 ± 0.7, p = 0.001; LVEF 53.0 ± 8.2 versus 56.9 ± 7.0 %, p < 0.05; LV diastolic diameter 53.6 ± 5.8 mm versus 50.7 ± 4.9 mm, p < 0.05; N-terminal pro-brain natriuretic peptide (NT-proBNP) 1116.8 ± 883.9 versus 622.9 ± 1059.4 pg/ml, p < 0.05. Progression of paroxysmal AF to permanent AF during follow-up was common, while new onset of AF was rare. Permanent AF was an independent predictor of declining LVEF >10 %, increasing NYHA class ≥1, and NT-proBNP levels >1,000 pg/ml.

Conclusions

Permanent AF was associated with adverse effects on LV function and symptoms of HF in patients with long-term RV pacing for complete heart block, and appears to play an important role in the development of HF in this specific patient cohort.

Keywords

Atrial fibrillationAtrioventricular nodeAblationPacemakerHeart failure

Copyright information

© Springer-Verlag 2012