This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cha, Y.-M. Articles by Gersh, B. J. Search for Related Content PubMed PubMed Citation Articles by Cha, Y.-M. Articles by Gersh, B. J. Related Collections Congestive Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2004;109:2839-2843.)
© 2004 American Heart Association, Inc.

Clinician Update

Atrial Fibrillation and Ventricular Dysfunction

A Vicious Electromechanical Cycle

Yong-Mei Cha, MD; Margaret M. Redfield, MD; Win-Kuang Shen, MD; Bernard J. Gersh, MB, ChB, DPhil

From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn.

Reprint requests to Bernard J. Gersh, MB, ChB, DPhil, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail cha.yongmei@mayo.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Case Presentation: A 44-year-old man with a history of hypertension presented with New York Heart Association class IV congestive heart failure (CHF) and atrial fibrillation (AF) with rapid ventricular response (160 beats per minute) and unknown onset. Transthoracic and transesophageal echocardiography demonstrated severe global left ventricular (LV) dilatation, LV ejection fraction (LVEF) of 20%, and a mobile thrombus in the left atrial appendage but no evidence of coronary artery disease or valvular heart disease. After treatment with furosemide, digoxin, metoprolol, lisinopril, and warfarin, a repeat transesophageal echocardiogram 4 weeks later showed resolution of the thrombus. Subsequent attempts at cardioversion were unsuccessful despite treatment with sotalol hydrochloride and amiodarone. An average heart rate of less than 80 beats per minute was achieved after treatment with diltiazem hydrochloride, metoprolol, and digoxin. Three months later, the patient’s LVEF was 55% with mild LV enlargement.

	Prevalence

 
AF and CHF are recognized as 2 major epidemics of cardiovascular disease in the 21st century.¹ In 1995, AF was reported to be the most common cardiac arrhythmia, affecting more than 2 million people in the United States alone.² According to 2001 estimates, CHF affects more than 4 million Americans.³ The prevalence of CHF increases from 0.8% among persons 50 to 59 years of age to 6.6% among persons 80 to 89 years of age.⁴ Similarly, the prevalence of AF more than doubles with each decade of age, from 0.5% at age 50 (50 to 59 years) to 9% at age 80 (80 to 89 years).⁵ Thus, these burgeoning . . . [Full Text of this Article]

This article has been cited by other articles:

				R. Jhanjee, G. A. Templeton, S. Sattiraju, J. Nguyen, S. Sakaguchi, F. Lu, C. Ermis, S. Milstein, L. Van Heel, K. G. Lurie, et al. Relationship of Paroxysmal Atrial Tachyarrhythmias to Volume Overload: Assessment by Implanted Transpulmonary Impedance Monitoring Circ Arrhythm Electrophysiol, October 1, 2009; 2(5): 488 - 494. [Abstract] [Full Text] [PDF]

				L. F. Tops, D. W. Den Uijl, V. Delgado, N. A. Marsan, K. Zeppenfeld, E. Holman, E. E. van der Wall, M. J. Schalij, and J. J. Bax Long-Term Improvement in Left Ventricular Strain After Successful Catheter Ablation for Atrial Fibrillation in Patients With Preserved Left Ventricular Systolic Function Circ Arrhythm Electrophysiol, June 1, 2009; 2(3): 249 - 257. [Abstract] [Full Text] [PDF]

				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]

				H. R. Halperin and S. Nazarian Damage Assessment After Ablation: Role of Cardiovascular Magnetic Resonance J. Am. Coll. Cardiol., October 7, 2008; 52(15): 1272 - 1273. [Full Text] [PDF]

				L. Padeletti, P. Pieragnoli, V. Jentzen, and A. Schuchert The comorbidity of atrial fibrillation and heart failure: a challenge for electrical therapies Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I81 - I86. [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]

				Y. Miyasaka, M. E. Barnes, B. J. Gersh, S. S. Cha, K. R. Bailey, W. Abhayaratna, J. B. Seward, T. Iwasaka, and T. S.M. Tsang Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: a community-based study over two decades Eur. Heart J., April 2, 2006; 27(8): 936 - 941. [Abstract] [Full Text] [PDF]

				V. M. C. Salemi, E. Arteaga, and C. Mady Recovery of systolic and diastolic function after ablation of incessant supraventricular tachycardia Eur J Heart Fail, December 1, 2005; 7(7): 1177 - 1179. [Abstract] [Full Text] [PDF]

				P. Dorian, I. Mangat, A. Pinter, and V. Korley The Burden of Atrial Fibrillation: Should We Abandon Antiarrhythmic Drug Therapy? Journal of Cardiovascular Pharmacology and Therapeutics, October 1, 2004; 9(4): 257 - 262. [Abstract] [PDF]