https://doi.org/10.1007/s00392-025-02625-4
1Universitäts-Herzzentrum Freiburg / Bad Krozingen Klinik für Kardiologie und Angiologie Bad Krozingen, Deutschland; 2Universitäts-Herzzentrum Freiburg / Bad Krozingen Klinik für Kardiologie und Angiologie II Bad Krozingen, Deutschland; 3Universitäts-Herzzentrum Freiburg / Bad Krozingen Rhythmologie Bad Krozingen, Deutschland
Background
Atrial fibrillation (AF) and heart failure (HF) are closely entangled, and presence of AF worsens prognosis in patients with HF significantly. Restoration of sinus rhythm might improve systolic function and improve consecutive mortality and rehospitalization rates. The prevalence and number of “responders” of sinus rhythm in heart failure patients, patients with so called AF-related or -aggravated cardiomyopathy is unknown.
Methods
We retrospectively identified all patients admitted for electrical cardioversion between 2016 and 2023 and at least one transthoracic echocardiography prior to cardioversion. Repeated TTE for course of LVEF was considered between 1 day until 1 year after cardioversion and if patient was in sinus rhythm. AF burden in patients with intracardiac ECGs was calculated during first 6 months after cardioversion. The primary objective was to evaluate percentage of patients with improving LV function during sinus rhythm. Secondary endpoints included all-cause mortality, first rehospitalization due to heart failure and AF burden in patients with intracardiac devices.
Results
In total 6032 patients admitted for electrical cardioversion were identified. Of them, 54% (3238 patients) showed decreased LVEF during AF (1573 LVEF 40-50%; 951 LVEF 30-40%; 714 LVEF <30%). Of those 1665 patients with LVEF <40% during AF, 871 still showed LVEF <40% during follow-up (1day-1 year) in sinus rhythm (514 with LVEF 30-40%; 357 with LVEF <30%). 112 patients were excluded due to missing LVEF or recurrent AF. All-cause mortality among patients with LVEF 30-40% was 13.1% and 14.5% among patients with LVEF <30% (p=n.s.). From 368 patients intracardiac ECGs were available and AF burden was higher in patients with LVEF 30-40%. Notably, 43% of all patients showed 0% AF burden during 6 months period after cardioversion.
Conclusion
In our single-center experience more than half of all patients admitted for cardioversion reveal decreased LV function during AF with a significant part AF-mediated cardiomyopathy. Patients with LVEF <40% show comparable all-cause mortality rates with previously published randomized trials. A considerable part of HF patients remains in stable sinus rhythm during first 6 months after cardioversion.