Morbidity and Mortality Outcomes in Atrial Fibrillation Patients with Different Phenotypes of Heart Failure

Background: Atrial fibrillation (AF) is the most common arrhythmia in heart failure (HF), with both preserved and reduced ejection fraction (EF), worsening the prognosis. the prognostic implications of AF in HF remain controversial. Aim of the Work: evaluation of the outcomes in with AF patients and various HF phenotypes. Patients and methods: The study conducted on 90 symptomatic HF patients presented by AF (either paroxysmal or non-paroxysmal). They were classified into three groups: HF with preserved ejection fraction (HFpEF), HF with mildly reduced EF (HFmrEF), HF with reduced EF (HFrEF). All participants were subjected to thorough history taking, ECG and comprehensive echo-Doppler evaluation including left ventricular (LV) dimensions and functions, left atrial (LA) volume and 2D-speckle tacking echocardiography for assessment of LV longitudinal strain (LV-GLS) and LA phasic function. Results: Patients with HFrEF had more significant LA structural and functional changes than those with HFpEF and HFmrEF, including LA enlargement and reduced LA phasic function. In comparison to patients with paroxysmal AF, non-paroxysmal AF patients in all HF groups had larger LA diameters and higher LA volumes. In HFrEF patients, non-paroxysmal AF had a substantially higher all-cause morbidity than paroxysmal AF. Conclusions: Only in patients with HFrEF experienced all-cause morbidity substantially higher in non-paroxysmal AF than in paroxysmal AF, according to all-cause mortality and morbidity within HF categories. Nevertheless, non-paroxysmal and paroxysmal AF did not differ in all-cause mortality within recruited HF group.