Beta-blockers are effective in congestive heart failure patients with atrial fibrillation.

BACKGROUND

It is controversial whether or not beta-blockers are effective in patients with congestive heart failure (CHF) who are complicated by persistent atrial fibrillation (AF).

METHODS

We attempted to determine the potential differences in the efficacy between atrial fibrillation and sinus rhythm in 70 CHF patients with NYHA class II-IV and radionuclide ejection fraction (LVEF) <40% who received metoprolol or carvedilol over 16 weeks.

RESULTS

Left ventricular end-diastolic dimension was decreased in AF group (n=24) 4 weeks (early) and 16 to 48 weeks (late) after introduction of beta-blockers (P<.05, P<.001), but not in the sinus rhythm (NSR) group (n=46). End-systolic dimension was decreased in both the AF group (P<.01, P<.0001) and the NSR group (P<.01, P<.0001). LVEF was increased in both the AF group (P<.0005, P<.0001) and the NSR group (P<.0001, P<.0001) early and late after the therapy. Increase in LVEF by the therapy tended to be higher in the AF group than in the NSR group (P=.056). Plasma brain natriuretic peptide level did not change significantly throughout the observation period, although the level tended to be lowered in the AF group late after introduction of beta-blockers (P=.093).

CONCLUSIONS

Because beta-blockers are effective in both NSR and AF patients with CHF, such a mode of therapy should be recommended in patients with AF.