β-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.