Improving survival for patients with atrial fibrillation and advanced heart failure

J Am Coll Cardiol. 1996 Nov 15;28(6):1458-63. doi: 10.1016/s0735-1097(96)00358-0.


Objectives: We attempted to determine whether changes in heart failure therapy since 1989 have altered the prognostic significance of atrial fibrillation.

Background: Atrial fibrillation occurs in 15% to 30% of patients with heart failure. Despite the recognized potential for adverse effects, the impact of atrial fibrillation on prognosis is controversial.

Methods: Two-year survival for 750 consecutive patients discharged from a single hospital after evaluation for heart transplantation from 1985 to 1989 (Group I, n = 359) and from 1990 to April 1993 (Group II, n = 391) was analyzed in relation to atrial fibrillation. In Group I, class I antiarrhythmic drugs and hydralazine vasodilator therapy were routinely allowed. In Group II, amiodarone and angiotensin-converting enzyme inhibitors were first-line antiarrhythmic and vasodilating drugs.

Results: A history of atrial fibrillation was present in 20% of patients in Group I and 24% of those in Group II. Patients with atrial fibrillation in the two groups had similar clinical and hemodynamic profiles. Among patients with atrial fibrillation, those in Group II had a markedly better 2-year survival (0.66 vs. 0.39, p = 0.001) and sudden death-free survival (0.84 vs. 0.70, p = 0.01) than those in Group I. In each time period, survival was worse for patients with than without atrial fibrillation in Group I (0.39 vs. 0.55, p = 0.002) but not in Group II (0.66 vs. 0.75, p = 0.09).

Conclusions: The prognosis of patients with advanced heart failure and atrial fibrillation is improving. These findings support the practice of avoiding class I antiarrhythmic drugs in this group and may reflect recent beneficial changes in heart failure therapy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Amiodarone / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Anti-Arrhythmia Agents / therapeutic use
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / drug therapy
  • Cardiac Output, Low / complications*
  • Cardiac Output, Low / mortality*
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Humans
  • Hydralazine / therapeutic use
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Survival Rate
  • Treatment Outcome
  • Vasodilator Agents / therapeutic use


  • Angiotensin-Converting Enzyme Inhibitors
  • Anti-Arrhythmia Agents
  • Vasodilator Agents
  • Hydralazine
  • Amiodarone