AF mediated cardiomyopathy- not so benign after all?
I ChungAbstract
Background
Catheter ablation is a class I indicated for Atrial fibrillation (AF) mediated cardiomyopathy (CMP), diagnosis can be challenging and usually made by exclusion. The study is to assess the outcome of AF mediated CMP with guideline directed medical therapy prior to catheter ablation era.
Method
455 patients with Non-ischaemic Cardiomyopathy (NICMP), heart failure with reduced left ventricular ejection fraction (LVEF<40% and significant coronary artery disease >70% stenosis has been excluded). AF mediated CMP was defined as LVEF improved to more than 40% or LVEF normalized to 55% or above after medical treatment). Continuous variables were compared by Student t tests and categorical variables compared by use of the Fisher exact test. Clinical endpoints include cardiovascular death (CVD), hospitalization for heart failure (HHF) were recorded.
Results
Mean age 62.95 ± 14.16 years, male 70% and younger. Mean age for male and female were 61.18 ± 13.60 and 67.11 ± 14.61 years respectively. Hypertension 76% Diabetes mellitus 38%, atrial fibrillation 38%, previous stroke 8%. 69 patients were diagnosed with AF mediated CMP (40%), 61% males. Ivabradine 10%, b-blocker 90%, Angiotensin inhibitors/Angiotensin Receptor Blocker 66%, Sacubitrial/ Valsartan 28%, spironolactone 59%, SGLT-2 inhibitor 11%. Median follow-up duration of 4.3 (0.59-7.73) years. There were 2 CVD, 1 male and female each and 27 patients with HHF.
Conclusions
AF mediated CMP is common, account for 40% of AF patients with NICMP, CVD is low but frequent hospitalizations for heart failure. Appropriate interventions, guideline directed medical therapy and AF ablation should be achievable to improve clinical outcomes further.