Impact of rate versus rhythm control strategy on left ventricle function in patients with persistent atrial fibrillation, one year follow-up

characteristics and outcomes associated with new atrial fibrillation (AF) in the setting of acute myocardial infarction (AMI) in patients under 65 years. Methods: We examined 320 patients under 65 years of age with AMI, comparing patients with AF (n=114) to those without (n=206). Univariable and multivariable analysis were used to assess relation between baseline factors and development of atrial fibrillation. Correlation analysis through Pearson coefficient was performed to determine relation between clinical parameters and left ventricular ejection fraction (LVEF). Results: Patients with AF had more often anterior Q wave MI, higher peak croat±no kinase (CK) levels, more advanced heart failure (HF) as well as more extensive LV systolic dysfunction. They were also more likely to have had a history of diabetes mellitus and previous angina pectoris. Significant multivariable predictor of AF was worse Killip class. Lower LVEF highly correlated with previous MI (p<0.0001), anterior MI (p<0.0001), congestive HF (p<0.0001), CK levels (p=0.001) and risk for development of AF (p=0.001). The unadjusted in-hospital mortality rate was significantly higher in patients with AF (14%) than in patients without AF (6.8%), p=0.03. After adjustment for baseline characteristics, the presence of HF (odds ratio [OR] =4.7) was associated with increased in-hospital mortality. The unadjusted mortality rate was significantly higher at 7year (36.1% vs. 18.8%, p=0.001) in patients with AE The adjusted 7year mortality rate remained significantly higher with HF (OR= 3.3). Conclusion: HF in AMI complicated by AF independently predicts in-hospital and long term mortality in patients under 65 years, and not the AE