Joseph N Gigliotti1,2, Mandeep S Sidhu3,4, Alina M Robert5, Jonathan S Zipursky6, Jeremiah R Brown7, Salvatore P Costa1, Robert T Palac2,8, David A Steckman3,4, David J Malenka1,2, Alan T Kono1,2, Mark L Greenberg1,2. 1. Department of Medicine(Cardiology), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 2. Department of Medicine(Cardiology), Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire. 3. Department of Medicine(Cardiology), Albany Medical Center, Albany, New York. 4. Department of Medicine(Cardiology), Albany Medical College, Albany, New York. 5. Department of Medicine(Cardiology), St. Luke's Clinic, Boise, Idaho. 6. Department of Medicine(Cardiology), University of Toronto, Canada. 7. Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine, Hanover, New Hampshire. 8. Department of Medicine(Cardiology), White River Junction VA Medical Center, Vermont.
Abstract
BACKGROUND: Heart failure is a significant cause of morbidity and mortality, yet patient risk stratification may be difficult. Prevention or treatment of atrial fibrillation (AF) may be an important strategy in these patients that could positively affect their outcome. It has been demonstrated that in patients with systolic dysfunction, prolonged QRS duration (QRSd), an easily measured electrocardiographic parameter, is associated with AF. HYPOTHESIS: Prolonged QRSd is associated with an increase in prevalence of AF in patients with heart failure with preserved ejection fraction(HFPEF). METHODS: Between February 2006 and February 2009, 718 patients were discharged with a diagnosis of HF from the Dartmouth-Hitchcock Medical Center. Of these, 206 had EF ≥50% by echocardiography performed within 72 hours of admission. After exclusions, 82 patients remained, of which 25 had AF and 57 had sinus rhythm. Characteristics of the AF and sinus-rhythm patients were compared in this pilot study. RESULTS: After adjustment for age, prior diagnosis of HF, and left atrial area, there was a nonsignificant trend (odds ratio: 2.2, 95% CI of 0.3-17.2) for a QRSd >120 ms to be associated with AF. CONCLUSIONS: Similar to results in patients with systolic dysfunction, patients with preserved EF may have an association between a prolonged QRSd and AF.
BACKGROUND:Heart failure is a significant cause of morbidity and mortality, yet patient risk stratification may be difficult. Prevention or treatment of atrial fibrillation (AF) may be an important strategy in these patients that could positively affect their outcome. It has been demonstrated that in patients with systolic dysfunction, prolonged QRS duration (QRSd), an easily measured electrocardiographic parameter, is associated with AF. HYPOTHESIS: Prolonged QRSd is associated with an increase in prevalence of AF in patients with heart failure with preserved ejection fraction(HFPEF). METHODS: Between February 2006 and February 2009, 718 patients were discharged with a diagnosis of HF from the Dartmouth-Hitchcock Medical Center. Of these, 206 had EF ≥50% by echocardiography performed within 72 hours of admission. After exclusions, 82 patients remained, of which 25 had AF and 57 had sinus rhythm. Characteristics of the AF and sinus-rhythm patients were compared in this pilot study. RESULTS: After adjustment for age, prior diagnosis of HF, and left atrial area, there was a nonsignificant trend (odds ratio: 2.2, 95% CI of 0.3-17.2) for a QRSd >120 ms to be associated with AF. CONCLUSIONS: Similar to results in patients with systolic dysfunction, patients with preserved EF may have an association between a prolonged QRSd and AF.
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