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

  • Brigitte Lampe
  • Christoph Hammerstingl
  • Jörg Otto Schwab
  • Fritz Mellert
  • Birgit Stoffel-Wagner
  • Andreas Grigull
  • Rolf Fimmers
  • Bernhard Maisch
  • Georg Nickenig
  • Thorsten Lewalter
  • Alexander Yang
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

Authors and Affiliations

  • Brigitte Lampe
    • 1
  • Christoph Hammerstingl
    • 1
  • Jörg Otto Schwab
    • 1
  • Fritz Mellert
    • 2
  • Birgit Stoffel-Wagner
    • 3
  • Andreas Grigull
    • 3
  • Rolf Fimmers
    • 4
  • Bernhard Maisch
    • 5
  • Georg Nickenig
    • 1
  • Thorsten Lewalter
    • 1
  • Alexander Yang
    • 1
    • 6
  1. 1.Department of CardiologyUniversity of BonnBonnGermany
  2. 2.Department of Cardiac SurgeryUniversity of BonnBonnGermany
  3. 3.Department of Clinical Chemistry and Clinical PharmacologyUniversity of BonnBonnGermany
  4. 4.Department of Statistics and Medical BiometryUniversity of BonnBonnGermany
  5. 5.Department of CardiologyPhilipps UniversitätMarburgGermany
  6. 6.Medizinische Klinik und Poliklinik IIUniversitätsklinikum BonnBonnGermany