Impact of Atrial Fibrillation on Outcome of Patients with Idiopathic Dilated Cardiomyopathy: Data from the Heart Muscle Disease Registry of Trieste

Abstract

Objective: There is a paucity and inconsistency of data regarding the natural history of patients affected by idiopathic dilated cardiomyopathy (IDCM) and atrial fibrillation (AF). We examined the prognostic implications of AF in a subset of patients with IDCM. Methods:We analyzed the data of 539 patients with IDCM enrolled in the Heart Muscle Disease Registry of Trieste.Results: At baseline, 52 (9.6%) of 539 patients had AF. There was no difference in survival of patients with either AF or sinus rhythm at enrollment (P=.28). During long-term follow-up (90±58 months), AF was detected on ECG/ECG-Holter monitoring in 28 (5.7%) of 487 patients in sinus rhythm at baseline. Predictors of new onset of AF at multivariate analysis were a more dilated left atrium (OR 1.35, 95% CI 1.06-1.72; P=.01) and a lower left ventricle ejection fraction (for 10% decrease, OR 2.41, 95% CI 1.24-4.69, P=.016). Patients developing AF had higher mortality/heart transplantation rate compared to patients who maintained sinus rhythm during follow-up (P<.001). At multivariate analysis, new onset AF (HR 3.67, 95% CI 2.07-6.5; P<.001) in the first three years after diagnosis, but not baseline AF, was found to be independently associated with a worse outcome. Conclusions:Atrial fibrillation is relatively frequent in patients with IDCM. The early development of AF during follow-up, but not its presence at baseline, is associated with poor survival.

Torasemide reduces dilated cardiomyopathy, complication of arrhythmia, and progression to heart failure

“…Electrical activity of injured atrium is inconsistent, so local conduction delays and effective refractory period increases. It is easy to form reentry, twists, turns and complex annular movement, ultimately leading to atrial fibrillation (Aleksova et al, 2010). Spontaneous activities were also confirmed as spontaneous contractions in papillary muscles from the left ventricle.…”

“…The risk factors for sudden cardiac death in DCM with implantable cardioverter defibrillator include asymptomatic nonsustained ventricular tachycardia and poor left ventricular function (Dimas et al, 2009). DCM patients complicated with atrial fibrillation have worse prognosis than the DCM patients with sinus rhythm (Aleksova et al, 2010).…”

Evolving concepts in dilated cardiomyopathy

“…Importantly, the development of new LBBB during follow‐up is a strong independent prognostic predictor of all‐cause mortality . Of note, CRT was shown to reduce the risk induced by LBBB, specifically in DCM patients, and should timely be considered after LBBB development during follow‐up. The onset of atrial fibrillation during the follow‐up is a sign of structural disease progression and negatively impacts the prognosis of these patients, despite effective treatments …”

“…• The onset of atrial fibrillation during the follow-up is a sign of structural disease progression and negatively impacts the prognosis of these patients, despite effective treatments. 32 The implications of these observations are that a multiparametric approach to diagnosis and long-term follow-up, not limited to LV systolic function and size alone, appears essential to improve the quality of clinical management of DCM patients ( Figure 5).…”

Evolution of Electrocardiographic Abnormalities in Association with Neuromuscular Disorders and Survival in Left Ventricular Hypertrabeculation/Noncompaction

“…Data about the prognostic relevance of ECG changes during follow-up are conflicting: In a cohort of 539 patients with IDC from Italy, new onset of atrial fibrillation during 90 months was an indicator of poor survival. 16 On the contrary, in a study from Germany of 480 patients with IDC, neither new left bundle branch block nor new onset of atrial fibrillation nor new ST/T depression were predictors of poor outcome during 47 months. 17 Most probably, differences in the patient population and in the therapy may explain these controversial results.…”