Clinical, echocardiographic and biological characteristics and short-term outcomes of patients with atrial fibrillation according to treatment regimen: a prospective observational study

Abstract

Atrial fibrillation (AF) is commonly associated with structural cardiac remodeling and multiple comorbidities. This study aimed to describe the demographic, echocardiographic, and biological profiles of AF patients and to assess short-term outcomes according to therapeutic regimens. A prospective observational study enrolled 81 atrial fibrillation patients, assessed via echocardiography, biochemical and hormonal analyses, and randomized to two treatment protocols, with follow-up at three and six months. Time-to-event outcomes were analyzed using Cox proportional hazards regression models, a p value of less than 0.05. The mean age of all patients was 64.4 ± 11.0 years; 51.6% ≥65 years; majority male). Left ventricular ejection fraction (LVEF) averaged 55.3%, with left atrial enlargement present in 81.1% of patients. Structural abnormalities included LV (49.5%) and right ventricular (46.3%) dilation, LVH (53.7%), and right atrial enlargement (48.4%). Heart failure (HF), mainly HFpEF, was observed in 46.3%. Renal impairment was present in 15.8% of patients, and hepatocytolysis in 48.4%. Thyroid disorders were observed in 17.9%. Comparisons between treatment regimens, direct oral anticoagulant (DOAC) plus beta-blocker versus DOAC plus class III antiarrhythmic, revealed comparable echocardiographic and biological parameters, except for a higher left atrial volume in the DOAC + beta-blocker group ( p = 0.045). Short-term outcomes showed non-inferiority of the DOAC + beta-blocker regimen and DOAC plus class III antiarrhythmic. AF patients exhibited high rates of atrial remodeling and comorbidities. Both therapeutic strategies were generally well tolerated, with comparable short-term outcomes, supporting the use of rate-control approaches in appropriately selected patients.