BACKGROUND: It is controversial whether or not beta-blockers are effective in patients with congestive heart failure (CHF) who are complicated by persistent atrial fibrillation (AF). METHODS: We attempted to determine the potential differences in the efficacy between atrial fibrillation and sinus rhythm in 70 CHF patients with NYHA class II-IV and radionuclide ejection fraction (LVEF) <40% who received metoprolol or carvedilol over 16 weeks. RESULTS: Left ventricular end-diastolic dimension was decreased in AF group (n=24) 4 weeks (early) and 16 to 48 weeks (late) after introduction of beta-blockers (P<.05, P<.001), but not in the sinus rhythm (NSR) group (n=46). End-systolic dimension was decreased in both the AF group (P<.01, P<.0001) and the NSR group (P<.01, P<.0001). LVEF was increased in both the AF group (P<.0005, P<.0001) and the NSR group (P<.0001, P<.0001) early and late after the therapy. Increase in LVEF by the therapy tended to be higher in the AF group than in the NSR group (P=.056). Plasma brain natriuretic peptide level did not change significantly throughout the observation period, although the level tended to be lowered in the AF group late after introduction of beta-blockers (P=.093). CONCLUSIONS: Because beta-blockers are effective in both NSR and AF patients with CHF, such a mode of therapy should be recommended in patients with AF.
BACKGROUND: It is controversial whether or not beta-blockers are effective in patients with congestive heart failure (CHF) who are complicated by persistent atrial fibrillation (AF). METHODS: We attempted to determine the potential differences in the efficacy between atrial fibrillation and sinus rhythm in 70 CHFpatients with NYHA class II-IV and radionuclide ejection fraction (LVEF) <40% who received metoprolol or carvedilol over 16 weeks. RESULTS: Left ventricular end-diastolic dimension was decreased in AF group (n=24) 4 weeks (early) and 16 to 48 weeks (late) after introduction of beta-blockers (P<.05, P<.001), but not in the sinus rhythm (NSR) group (n=46). End-systolic dimension was decreased in both the AF group (P<.01, P<.0001) and the NSR group (P<.01, P<.0001). LVEF was increased in both the AF group (P<.0005, P<.0001) and the NSR group (P<.0001, P<.0001) early and late after the therapy. Increase in LVEF by the therapy tended to be higher in the AF group than in the NSR group (P=.056). Plasma brain natriuretic peptide level did not change significantly throughout the observation period, although the level tended to be lowered in the AF group late after introduction of beta-blockers (P=.093). CONCLUSIONS: Because beta-blockers are effective in both NSR and AFpatients with CHF, such a mode of therapy should be recommended in patients with AF.