Skip Navigation

European Journal of Heart Failure 2006 8(6):591-598; doi:10.1016/j.ejheart.2005.11.007
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (4)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Køber, L.
Right arrow Articles by Califf, R. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Køber, L.
Right arrow Articles by Califf, R. M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© 2005 European Society of Cardiology

Previously known and newly diagnosed atrial fibrillation: A major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction{star}

Lars Købera,*, Karl Swedbergb, John J.V. McMurrayc, Marc A. Pfefferd, Eric J. Velazqueze, Rafael Diazf, Aldo P. Maggionig, Viatcheslav Mareevh, Grzegorz Opolskii, Frans Van de Werfj, Faiez Zannadk, Georg Ertll, Scott D. Solomond, Steven Zelenkofskem, Jean-Lucien Rouleaun, Jeffrey D. Leimbergere and Robert M. Califfe

a Department of Cardiology, Non-Invasive Lab, Rigshospitalet 9 Blegdamsvej, Copenhagen, Denmark, 2100 Ø
b Sahlgrenska University Hospital/Østra Göteborg, Sweden
c University of Glasgow Glasgow, United Kingdom
d Brigham and Women's Hospital Boston, MA, United States
e Duke Clinical Research Institute, Duke University Medical Center Durham, NC, United States
f Estudios Cardiologicos Lationamerica Santa Fe, Argentina
g ANMCO Research Center Florence, Italy
h Myasnikov Card. Research Institute Moscow, Russia
i Centralny Szpital Kliniczny Akademii Medycznej Warsaw, Poland
j Gasthuisberg University Hospital Leuven, Belgium
k CIC INSERM-CHU Nancy France
l Julius-Maximilians-Universität Medizinische Würzburg, Germany
m Novartis Pharmaceuticals Corporation East Hanover, NJ, United States
n Toronto Hospital Toronto, Ontario, Canada

* Corresponding author. Tel.: +45 35 45 21 48; fax: +45 39 76 01 07. E-mail address: LK{at}HEART.DK (L. Køber).


   Abstract
Top
 Notes
 Abstract
1. Methods
 2. Statistical analysis
 3. Results
 4. Discussion
 5. Conclusion
 References
 
Aims: To characterize the relationship between known and newly diagnosed atrial fibrillation (AF) and the risk of death and major cardiovascular (CV) events in patients with acute myocardial infarction (MI) complicated by heart failure (HF) and/or left ventricular systolic dysfunction (LVSD).

Methods: The VALIANT trial enrolled 14,703 individuals with acute MI complicated by HF and/or LVSD. AF was assessed at presentation and at randomization (median 4.9 days after symptom onset). Primary outcomes were risk of death and major CV events 3 years following acute MI.

Results: A total of 1812 with current AF (AF between presentation and randomization), 339 patients with prior AF (history of AF without current AF), and 12,509 without AF were enrolled. Patients with AF were older; had more prior HF, angina, and MI, and received beta-blockers and thrombolytics less often than those without AF. Three-year mortality estimates were 20% in those without AF, 37% with current AF, and 38% with prior AF. Compared with patients without AF, the multivariable adjusted HR of death was 1.25 (1.03–1.52; p = 0.03) for prior AF and 1.32 (1.20–1.45; p < 0.0001) for current AF. HR for major CV events was 1.15 (0.98–1.35; p = 0.08) and 1.21 (1.12–1.31; p < 0.0001).

Conclusion: AF is associated with greater long-term mortality and adverse CV events with acute MI complicated by HF or LVSD.

Key Words: Atrial fibrillation • Prognosis • Acute myocardial infarction

Received February 28, 2005; Revised August 28, 2005; Accepted November 17, 2005

The prognostic significance of atrial fibrillation (AF) in acute myocardial infarction (MI) is controversial. Some studies have found that AF is an independent predictor of inpatient and longer-term mortality though follow-up has been limited in most published series; other studies did not reach this conclusion. The most recent trials report an increased mortality associated with AF following acute MI [1-5].Similarly, there is a conflict in the literature concerning the impact of AF on mortality in patients with chronic heart failure (HF) [6-11].

Even less information is available on the relationship between AF and nonfatal cardiovascular (CV) events (and composite fatal and nonfatal outcomes) after MI. AF might have particular prognostic importance in patients with left ventricular systolic dysfunction (LVSD), HF, or both complicating acute MI as these patients are already at high risk of adverse CV outcomes. Therefore, we have examined the relationship between AF and long-term (3 years) fatal and nonfatal outcomes in the valsartan in acute myocardial infarction (VALIANT) Trial.


   1. Methods
Top
 Notes
 Abstract
 1. Methods
2. Statistical analysis
 3. Results
 4. Discussion
 5. Conclusion
 References
 
1.1. Enrollment and data collection
VALIANT is a multinational, randomized, active-controlled trial comparing the effects of valsartan, captopril, or their combination in the treatment of individuals presenting with an acute MI complicated by clinical or radiologic signs of HF, reduced LVSD, or both. Inclusion criteria included age ≥18 years and acute MI symptom onset between 12 h and 10 days prior to randomization. Exclusion criteria included cardiogenic shock; serum creatinine >2.5 mg/dl; known intolerance of, or contraindication to, an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor antagonist; and serious disease, other than acute MI, severely limiting life expectancy. The design, baseline characteristics, and main results of the study have been published previously [12-14].

Assessment of individual AF status occurred at 2 times during the enrollment period: at the time of presentation with acute MI and at randomization, which occurred a median of 4.9 days (range 0.5-10 days) after symptom onset. At randomization, investigators registered whether the patient experienced AF from the time of qualifying MI to randomization. Patients with a history of AF but without AF at presentation with MI or from presentation to randomization were registered as ‘prior AF’. If patients had AF at presentation or experienced at least 1 episode of AF in the period until randomization, they were registered as ‘current AF.’ Patients with both a history of AF and current AF were registered as ‘current AF.’


   2. Statistical analysis
Top
 Notes
 Abstract
 1. Methods
 2. Statistical analysis
3. Results
 4. Discussion
 5. Conclusion
 References
 
The primary outcomes were risk of death and major CV events in the 3 years following the acute MI. Continuous variables were presented as medians, 25th, 75th percentiles unless otherwise specified. Differences in baseline demographics between groups were ascertained by using ANOVA for continuous variables if assumptions of normality were met. If not, groups were compared using the Wilcoxon rank-sum test. Pearson Chi-squared tests or Fisher's Exact Test were used for comparisons of categorical and ordinal data. Two-sided p-values<0.01 were considered significant.

Cox proportional hazards models were used to assess the association between AF status and the development of long-term mortality. Both unadjusted and multivariable-adjusted hazard ratios (HR) are presented. Several multivariable models were constructed using >70 candidate variables. Patients with current and prior AF were compared with patients without AF. The final mortality model included the following variables: age, pulse pressure, baseline creatinine, heart rate, weight, anterior MI, new left bundle branch block, smoking status, Killip class at qualifying MI, history of angina, history of HF, history of unstable angina, history of peripheral arterial disease, history of alcohol abuse, history of stroke, history of chronic obstructive pulmonary disease, prior MI, use of percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), or thrombolytics prior to randomization, previous hospitalizations, renal function, diabetes status, country of enrollment, and randomized treatment. All multivariable analyses were repeated dividing the current AF group into two groups, according to whether AF were only current or had also been present previously. In multivariable analyses these 2 groups had identical risk and where thus reported together.


   3. Results
Top
 Notes
 Abstract
 1. Methods
 2. Statistical analysis
 3. Results
4. Discussion
 5. Conclusion
 References
 
In VALIANT, 14,703 patients were randomly assigned, including 339 with prior AF (2.3%), 1812 with current AF (12.3%), and 12,509 without AF (85.1%). Information concerning AF status was missing in 43 patients (0.3%).

Baseline characteristics for each group as well as the combined AF group are described in Table 1. The baseline demographics of patients with current AF were similar to those of patients with prior AF with respect to age, sex, body mass index, smoking, diabetes status, and previous stroke. Patients with current AF had less hypertension, dyslipidemia, peripheral arterial disease, previous MI, HF, revascularization, or angina compared with patients with prior AF. Patients without AF were more similar to patients with current AF than with patients with prior AF. However, patients without AF were younger, more likely to smoke, had less hypertension, prior MI, HF, stroke, and angina than patients with prior or current AF. Thus, patients with prior AF had the worst risk profile, and patients without AF had the best.


View this table:
[in this window]
[in a new window]

  		Table 1 Baseline demographics and medical history

 
At the time of randomization (Table 2), patients with current AF had the fastest heart rate and the highest Killip classification. Patients without AF had a heart rate between prior and current AF patients. Additionally, patients with prior AF were more likely to have a non-Q wave MI than patients with current AF or patients without AF. Patients without AF had the lowest creatinine.


View this table:
[in this window]
[in a new window]

  		Table 2 Characteristics of qualifying myocardial infarction and medications at randomization

 
The initial treatment of the qualifying acute MI is also presented in Table 2. Patients without AF were more likely to receive aspirin, beta-blockers, thrombolytics, and primary percutaneous coronary intervention (PCI) than patients with current or prior AF. Patients with any AF (prior or current) were more likely to receive oral anticoagulant treatment, digoxin, and amiodarone than patients without AF. This trend was unchanged after 1 year in the study.

3.1. Mortality
Although the baseline characteristics and treatment of patients with current AF were more similar to those of patients without AF, the mortality rate of patients with current AF was more similar to that of patients with prior AF (Fig. 1). A total of 570 (31.5%) patients with current AF, 110 (32.5%) with prior AF, and 2172 (17.4%) without AF had died at 3 years. Kaplan-Meier estimates of 3-year mortality and the unadjusted and adjusted HRs are presented in Table 3. After adjustment for baseline differences, patients with current and prior AF had a higher mortality than patients without AF. The HRs for the 2 groups with AF, compared with those without AF, were similar in magnitude. Sudden death was increased in patients with AF, but only to the same extent as non-sudden death.


Figure 1
View larger version (9K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Fig. 1 Mortality curves by atrial fibrillation status.

 


View this table:
[in this window]
[in a new window]

  		Table 3 Outcomes at 3 years

 
Secondary outcomes are presented in Table 3. The risk of MI was highest in patients with prior AF and similar in patients with current AF and those without AF. Stroke tended to be more common in both AF groups and was highest among patients with current AF (p<0.0001). HF was almost twice as common in both AF groups compared with the non-AF group. The combined endpoint of CV death, HF, acute MI, resuscitated cardiac arrest, or stroke occurred in nearly half of the patients with AF, compared with 30% of the patients without AF (Fig. 2). The adjusted HR for the combined endpoint was increased in patients with current AF (HR 1.21; CI 1.12-1.31) and prior AF (HR 1.15; 95% CI 0.98-1.35), compared with those without AF.


Figure 2
View larger version (10K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Fig. 2 Cardiovascular mortality and morbidity by atrial fibrillation status.

 
As in the randomized trial, there was no difference in mortality or CV events according to treatment with valsartan, captopril, or their combination in any of the patient subsets with or without AF (Fig. 3) [13].


Figure 3
View larger version (12K):
[in this window]
[in a new window]
[Download PowerPoint slide]
  		Fig. 3 Hazard ratios and 95% confidence intervals for death from any cause (panels A and C) and for death from cardiovascular causes, reinfarction, or hospitalization for heart failure (panels B and D). The valsartan group is compared with the captopril group in panels A and B; the valsartan and captopril combination group is compared with the captopril group in panels C and D.

 

   4. Discussion
Top
 Notes
 Abstract
 1. Methods
 2. Statistical analysis
 3. Results
 4. Discussion
5. Conclusion
 References
 
In this large cohort of high-risk patients presenting with acute MI, 12.3% had current AF. An additional 2.3% reported a history of AF, but did not have AF at the time of the index acute MI. Both current and prior AF were significant independent predictors of mortality during the 3 years following the acute MI. The hazard associated with current AF and prior AF was similar in magnitude, even though the demographic characteristics and initial treatment of the acute MI were different.

4.1. Atrial fibrillation and acute myocardial infarction
This study is consistent with previous studies demonstrating that patients presenting with acute MI and a history of AF have an increased mortality compared with patients without AF [1-5]. As in prior studies, patients with AF in VALIANT were older, had more CV comorbidities, and had a higher body mass index than patients without AF. Despite adjustment for these differences, AF was associated with an increased relative hazard of the order of 25% to 30%, which is of clinical relevance and should stimulate interest in finding optimal treatment for patients with AF. Interestingly, the cause of death did not seem to be affected, as AF was associated with both sudden and non-sudden death.

4.2. Newly diagnosed atrial fibrillation
In our study, a new diagnosis of AF at the time of MI was associated with an adverse prognosis. The increase in risk was similar in magnitude to that in patients with previously known AF, despite the newly diagnosed patients being younger and having less cardiac comorbidity. Recurrent MI was the only CV event which was not more common in these patients, compared with patients without AF. However, as more patients died in the AF groups, this may have masked an effect on recurrent MI. The combined endpoint of CV death and recurrent MI was significantly increased in both AF groups (Table 3). Although absolute numbers were low, the risk of stroke more than doubled in patients with current AF. Despite the known risk of thromboembolism with AF, only 20% of patients with current or prior AF received anticoagulant treatment at the time of randomization.

The etiology of AF in the post-acute MI setting is often multifactorial, but increased preload in conjunction with HF may play an important role. Patients who developed AF more often had clinical HF, as reflected by a higher Killip class. Similarly, they were older, which also predisposes patients to AF. Compared with the non-AF patients, other risk factors for AF, such as history of hypertension, were only slightly increased. It has also been suggested that AF is just a marker of more severe cardiac disease, which cannot be controlled in multivariable analyses. Since previous AF is associated with an increased risk despite having sinus rhythm at time of the infarction suggest that the factors causing AF, either historically or contemporaneously, are causative of the increased risk. The incidence of AF increases with left atrial size, and AF can be a marker of more atrial dilatation and fibrosis. Thus, AF may be a sign of an atrial cardiomyopathy. Mitral incompetence, which results in increased left atrial pressure and a dilated atrium, is also found frequently in patients after acute MI. An atrial cardiomyopathy associated with a dilated atrium, increased filling pressures, and increased levels of atrial natriuretic peptides is expected to result in a poor prognosis with respect to mortality, HF, and stroke. This suggests that treatment of AF should be focused more on the structural changes seen in the atria and on the prevention of thromboembolic events instead of on the arrhythmia itself. All patients in VALIANT received 1 of 3 randomized inhibitions of the renin angiotensin system, and we did not find a difference among these therapies in patients with and without AF at baseline. However, previous trials have shown that ACE inhibition may prevent the development of AF in patients following acute MI, so it is possible that all 3 treatments in this trial were similarly effective [15].

Only 61% of patients with current AF received beta-blocker therapy, compared with 72% of non-AF patients. This probably reflects the higher age of the AF patients as well as their greater comorbidity. Another possible explanation is reluctance to combine amiodarone and beta-blocker therapy. Patients with current AF were also less likely to be treated with fibrinolysis or primary PCI. This difference may have contributed to the increased risk of AF in these patients and was included as a covariate in the multivariable model.

4.3. Prior diagnosis of atrial fibrillation
Patients with a prior diagnosis of AF constituted only 2.3% of the total population and included patients with both paroxysmal and persistent AF. These patients had more previous heart failure and prior MI than current AF or non-AF patients. They had a poor prognosis with a high risk of death similar to patients with current AF. The risk of combined fatal and nonfatal CV outcomes was not significant in the multivariate model (possibly due to low numbers), but the 15% increased risk was consistent with the 21% increase for patients with current AF. These patients were more likely than non-AF patients to be taking amiodarone and anticoagulants. These treatments, together with beta-blocker therapy, may have prevented some of these patients from experiencing AF during the hospital stay for the index acute MI. Interestingly, after 3 years the estimated incidence of stroke was 5.1% in these patients compared with 8.1% in patients with current AF and 3.7% in patients without AF. This finding suggests, but does not prove, that a strategy of preventing AF may reduce future cerebral events. Two studies have compared rhythm control with rate control in much healthier AF patients, but neither of the studies found a benefit on hard endpoints with rhythm control [16,17]. However, these results are difficult to transfer to a population of post-acute MI patients with LVSD and/or HF.

Besides being a predictor of mortality, AF was a predictor of other important CV morbidities such as HF, stroke, and total hospitalizations. These outcomes were all increased in the relative magnitude of 15% to 30%, regardless of whether AF was prior or current. Whether the risk associated with AF can be reversed with treatment is an important clinical question, as this arrhythmia occurs in a high proportion of patients after MI. The finding that prior (without current) AF is an independent risk factor is also intriguing. This may be because AF recurs in these patients or because prior AF is a marker of poor prognosis in some other way. Either way, this is a high-risk subset of patients who merit intensive secondary preventive treatments and other treatments known to improve outcome.

4.4. Study limitations
There are several limitations to this study. Since the length of AF was not specified, we cannot exclude the possibility that further subdividing AF patients into groups according to severity of the arrhythmia would allow us to distinguish between patients without an increased risk and patients with an even worse prognosis. Secondly, we are not able to report if patients in sinus rhythm developed AF during follow-up. Because of this, we may have underestimated the risk associated with AF. Similarly, development of AF during the study was not registered, which may also underestimate the risk associated with AF.


   5. Conclusion
Top
 Notes
 Abstract
 1. Methods
 2. Statistical analysis
 3. Results
 4. Discussion
 5. Conclusion
References
 
In conclusion, both current AF and prior AF were associated with an increased risk of death and major CV events during the 3 years following an acute MI in patients with LVSD and/or clinical HF.


   Notes
Top
 Notes
Abstract
 1. Methods
 2. Statistical analysis
 3. Results
 4. Discussion
 5. Conclusion
 References
 
{star} The VALIANT trial was funded by a grant from Novartis Pharmaceutical Corporation, East Hanover, NJ, of which Dr. Zelenkofske is an employee. Back


   References
Top
 Notes
 Abstract
 1. Methods
 2. Statistical analysis
 3. Results
 4. Discussion
 5. Conclusion
 References
 

  1. Pizzetti F., Turazza F.M., Franzosi M.G., et al. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data. Heart (2001) 86:527–532.[Abstract/Free Full Text]
  2. Wong C.K., White H.D., Wilcox R.G., et al. New atrial fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience. Am Heart J (2000) 140:878–885.[CrossRef][Web of Science][Medline]
  3. Pedersen O.D., Bagger H., Kober L., et al. The occurrence and prognostic significance of atrial fibrillation/-flutter following acute myocardial infarction. TRACE Study group. TRAndolapril Cardiac Evaluation. Eur Heart J (1999) 20:748–754.[Abstract/Free Full Text]
  4. Eldar M., Canetti M., Rotstein Z., et al. Significance of paroxysmal atrial fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. Circulation (1998) 97:965–970.[Abstract/Free Full Text]
  5. Crenshaw B.S., Ward S.R., Granger C.B., et al. Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global utilization of streptokinase and TPA for occluded coronary arteries. J Am Coll Cardiol (1997) 30:406–413.[Abstract]
  6. Dries D.L., Exner D.V., Gersh B.J., et al. Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of left ventricular dysfunction. J Am Coll Cardiol (1998) 32:695–703.[Abstract/Free Full Text]
  7. Lechat P., Hulot J.S., Escolano S., et al. Heart rate and cardiac rhythm relationships with bisoprolol benefit in chronic heart failure in CIBIS II Trial. Circulation (2001) 103:1428–1433.[Abstract/Free Full Text]
  8. Middlekauff H.R., Stevenson W.G., Stevenson L.W. Prognostic significance of atrial fibrillation in advanced heart failure. A study of 390 patients. Circulation (1991) 84:40–48.[Abstract/Free Full Text]
  9. Stevenson W.G., Stevenson L.W., Middlekauff H.R., et al. Improving survival for patients with atrial fibrillation and advanced heart failure. J Am Coll Cardiol (1996) 28:1458–1463.[Abstract]
  10. Carson P.E., Johnson G.R., Dunkman W.B., et al. The influence of atrial fibrillation on prognosis in mild to moderate heart failure. The V-HeFT Studies. The V-HeFT VA Cooperative Studies Group. Circulation (1993) 87:VI102–VI110.[Medline]
  11. Crijns H.J., Tjeerdsma G., de Kam P.J., et al. Prognostic value of the presence and development of atrial fibrillation in patients with advanced chronic heart failure. Eur Heart J (2000) 21:1238–1245.[Abstract/Free Full Text]
  12. Velazquez E.J., Pfeffer M.A., McMurray J.V., et al. Valsartan in acute myocardial infarction (VALIANT) trial: baseline characteristics in context. Eur J Heart Fail (2003) 5:537–544.[Abstract/Free Full Text]
  13. Pfeffer M.A., McMurray J.J., Velazquez E.J., et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med (2003) 349:1893–1906.[Abstract/Free Full Text]
  14. Pfeffer M.A., McMurray J., Leizorovicz A., et al. Valsartan in acute myocardial infarction trial (VALIANT): rationale and design. Am Heart J (2000) 140:727–750.[CrossRef][Web of Science][Medline]
  15. Pedersen O.D., Bagger H., Kober L., et al. Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation (1999) 100:376–380.[Abstract/Free Full Text]
  16. Van Gelder I.C., Hagens V.E., Bosker H.A., et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med (2002) 347:1834–1840.[Abstract/Free Full Text]
  17. Wyse D.G., Waldo A.L., DiMarco J.P., et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med (2002) 347:1825–1833.[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 CirculationHome page
E. Anter and D. J. Callans
Pharmacological and Electrical Conversion of Atrial Fibrillation to Sinus Rhythm Is Worth the Effort
Circulation, October 6, 2009; 120(14): 1436 - 1443.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
A. Goette, A. Bukowska, D. Dobrev, J. Pfeiffenberger, H. Morawietz, D. Strugala, I. Wiswedel, F.-W. Rohl, C. Wolke, S. Bergmann, et al.
Acute atrial tachyarrhythmia induces angiotensin II type 1 receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles
Eur. Heart J., June 1, 2009; 30(11): 1411 - 1420.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
E. Anter, M. Jessup, and D. J. Callans
Atrial Fibrillation and Heart Failure: Treatment Considerations for a Dual Epidemic
Circulation, May 12, 2009; 119(18): 2516 - 2525.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
J. Schmitt, G. Duray, B. J. Gersh, and S. H. Hohnloser
Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications
Eur. Heart J., May 1, 2009; 30(9): 1038 - 1045.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
A. Bukowska, U. Lendeckel, A. Krohn, G. Keilhoff, S. t. Have, K. H. Neumann, and A. Goette
Atrial fibrillation down-regulates renal neutral endopeptidase expression and induces profibrotic pathways in the kidney
Europace, October 1, 2008; 10(10): 1212 - 1217.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Heart FailHome page
D. Rusinaru, L. Leborgne, M. Peltier, and C. Tribouilloy
Effect of atrial fibrillation on long-term survival in patients hospitalised for heart failure with preserved ejection fraction
Eur J Heart Fail, June 1, 2008; 10(6): 566 - 572.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
H.-R. Neuberger, C. Mewis, D. J. van Veldhuisen, U. Schotten, I. C. van Gelder, M. A. Allessie, and M. Bohm
Management of atrial fibrillation in patients with heart failure
Eur. Heart J., November 1, 2007; 28(21): 2568 - 2577.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (4)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Køber, L.
Right arrow Articles by Califf, R. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Køber, L.
Right arrow Articles by Califf, R. M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?