Clinical analysis of atrial fibrillation after levosimendan treatment for acute decompensated heart failure: A propensity score-matched study

Levosimendan has demonstrated beneficial effects in the treatment of acute decompensated heart failure (ADHF). However, it is also associated with proarrhythmic effects owing to its influence on cardiac electrophysiology. We aimed to analyze the clinical features of atrial fibrillation (AF) after levosimendan treatment in patients with ADHF and to identify the predictors of AF after levosimendan treatment. The data of patients with ADHF treated with levosimendan were propensity score-matched and retrospectively analyzed. This study retrospectively collected patients admitted to the emergency department between 2021 and 2024 with a diagnosis of acute decompensated heart failure who received levosimendan therapy. Overall, 38 patients (16.8%) developed AF after levosimendan treatment. Levosimendan therapy was an independent predictor of AF (odds ratio 1.442, 95% confidence interval 1.005-2.067; P = .014). Patients who developed AF were older (P < .001) and more likely to have comorbid left atrial enlargement (P < .001) and previous AF/atrial flutter (P = .004). Patients with AF after levosimendan treatment had a longer median in-hospital stay than those without AF. Age (P = .005), left atrial enlargement (P = .032), and history of atrial flutter/AF (P = .002) were significant predictors of AF after levosimendan treatment. The area under the receiver operating characteristic curve values for age, left atrial enlargement, and history of atrial flutter/AF for predicting AF after treatment with levosimendan were 0.679 (P < .001), 0.687 (P < .001), and 0.603 (P = .012), respectively. Age, left atrial enlargement, and previous atrial flutter/AF were independent predictors of AF after levosimendan treatment. Levosimendan-associated AF increased the length of in-hospital stay, but had no effect on in-hospital mortality. Although this was a retrospective study, the study was registered as a clinical study, and the registration numbers will be uploaded later.