© 2006 European Society of Cardiology
Presence and development of atrial fibrillation in chronic heart failure
Experiences from the MERIT-HF Study
a Department of Cardiology, Thoraxcenter, University Medical Center Groningen PO Box 30 001, 9700 RB Groningen, The Netherlands
b Department of Cardiology, University of Oslo Rikshospitalet, Oslo, Norway
c Centre Hospitalier Hutois Huy, Belgium
d Amphia Hospital Breda and Department of Clinical Pharmacology, University of Groningen The Netherlands
e Kuopio University Hospital Kuopio, Finland
f Clinical Science AstraZeneca, Mölndal, Sweden
g Nordic School of Public Health Göteborg, Sweden
h Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital Göteborg, Sweden
* Corresponding author. Tel.: +31 50 3611327; fax: +31 50 3614391. E-mail address: d.j.van.veldhuisen{at}thorax.umcg.nl
 |
Abstract |
|---|
Background: Atrial fibrillation is common in heart failure, but data regarding beta-blockade in these patients and its ability to prevent new occurrence of atrial fibrillation are scarce.
Methods: Baseline ECGs in MERIT-HF were coded regarding baseline rhythm, and outcome was analyzed in relation to rhythm. Occurrence of atrial fibrillation during follow-up was also analyzed.
Results: At baseline atrial fibrillation was diagnosed in 556 patients (13.9%). Mean metoprolol CR/XL dose in patients in atrial fibrillation (154 mg) and sinus rhythm (158 mg) was similar, as well as decrease in heart rate (14.8 and 13.7 bpm, respectively). Only 61 (total of 362) deaths occurred in those in atrial fibrillation at baseline, 31 on placebo and 30 on metoprolol (RR 1.0; 95% CI 0.61–1.65). During follow-up, new atrial fibrillation was observed in 85 patients on placebo and 47 patients on metoprolol (RR 0.53; 95% CI 0.37–0.76; p=0.0005).
Conclusion: First, given the wide confidence interval, it was impossible to detect an interaction between metoprolol and mortality in patients with atrial fibrillation and heart failure. Second, in patients with sinus rhythm at baseline, metoprolol reduced the incidence of atrial fibrillation during follow-up. However, we must be extremely cautious in over-interpreting effects in these subgroups.
Key Words: Atrial fibrillation • Sinus rhythm • Chronic heart failure • Beta-blockade • Metoprolol CR/XL • Prognosis
Received July 28, 2005; Revised November 14, 2005; Accepted January 26, 2006
1 Members of the MERIT-HF Study Group are given in Ref. [8].
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. G.F. Cleland and D. Cullington Digoxin: Quo Vadis? Circ Heart Fail, March 1, 2009; 2(2): 81 - 85. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Buck, M. Rienstra, A. H. Maass, W. Nieuwland, D. J. Van Veldhuisen, and I. C. Van Gelder Cardiac resynchronization therapy in patients with heart failure and atrial fibrillation: importance of new-onset atrial fibrillation and total atrial conduction time Europace, May 1, 2008; 10(5): 558 - 565. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A. Lutomsky, T. Rostock, A. Koops, D. Steven, K. Mullerleile, H. Servatius, I. Drewitz, D. Ueberschar, T. Plagemann, R. Ventura, et al. Catheter ablation of paroxysmal atrial fibrillation improves cardiac function: a prospective study on the impact of atrial fibrillation ablation on left ventricular function assessed by magnetic resonance imaging Europace, May 1, 2008; 10(5): 593 - 599. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 D. Dobre, D. J. van Veldhuisen, M. J.L. deJongste, and F. M. Haaijer-Ruskamp Prescription of beta-blockers in patients with advanced heart failure and preserved left ventricular ejection fraction. Clinical implications and survival Eur J Heart Fail, September 1, 2007; 9(9): 962 - 963. [Full Text] [PDF]
|
|