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* From the Department of Medicine, University of Iowa College of Medicine, Iowa City, and LaSalle Cardiology and Galesburg Cottage Hospital (Mr. Mathew), Galesburg, IL; National Heart, Lung, and Blood Institute (Dr. Hunsberger), National Institutes of Health, Bethesda, MD; Division of Cardiology (Dr. Fleg), Johns Hopkins Bayview Medical Center, Baltimore, MD; VA Medical Center (Ms. Mc Sherry and Dr. Williford), Perry Point, MD; and Division of Cardiology (Dr. Yusuf), McMaster University, Hamilton, Ontario, Canada.
Correspondence to: James Mathew, Department of Cardiology, Galesburg Cottage Hospital, 695 N. Kellogg St, Galesburg, IL 61401
Background: The incidence, predictive factors, morbidity, and mortality associated with the development of supraventricular tachyarrhythmias (SVTs) in patients with congestive heart failure (CHF) are poorly defined.
Methods: In the Digitalis Investigation Group trial, patients with CHF who were in sinus rhythm were randomly assigned to digoxin (n = 3,889) or placebo (n = 3,899) and followed up for a mean of 37 months. Baseline factors that predicted the occurrence of SVT and the effects of SVT on total mortality, stroke, and hospitalization for worsening CHF were determined.
Results: Eight hundred sixty-six patients (11.1%) had SVT during the study period. Older age (odds ratio [OR], 1.029 for each year increase in age; p = 0.0001), male sex (OR, 1.270; p = 0.0075), increasing duration of CHF (OR, 1.003 for each month increase in duration of CHF; p = 0.0021), and a cardiothoracic ratio of > 0.50 (OR, 1.403; p = 0.0001) predicted an increased risk of experiencing SVT. Left ventricular ejection fraction, New York Heart Association functional class, and treatment with digoxin vs placebo were not related to the occurrence of SVT. After adjustment for other risk factors, development of SVT predicted a greater risk of subsequent total mortality (risk ratio [RR] = 2.451; p = 0.0001), stroke (RR = 2.352; p = 0.0001), and hospitalization for worsening CHF (RR = 3.004; p = 0.0001).
Conclusion: In CHF patients in sinus rhythm, older age, male sex, longer duration of CHF, and increased cardiothoracic ratio predict an increased risk for experiencing SVT. Development of SVT is a strong independent predictor of mortality, stroke, and hospitalization for CHF in this population. Prevention of SVT may prolong survival and reduce morbidity in CHF patients.
Key Words: atrial fibrillation • congestive heart failure • digoxin • stroke • supraventricular arrhythmia
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