فهرست نشریات علمی دسترسی آزاد ایران

   Background and Objectives: Levosimendan, a calcium sensitizer with inotropic and vasodilatory properties, has demonstrated efficacy in managing acute decompensated heart failure (ADHF). However, its proarrhythmic profile, particularly in the older adult population, where inotropic therapy is often used cautiously due to increased vulnerability to cardiac complications, remains poorly characterized. This study provides novel insights into the incidence and risk factors for arrhythmias, especially atrial fibrillation, among older adults with ADHF treated with levosimendan, a population frequently excluded from large, randomized trials.   Methods: A retrospective propensity score-matched analysis included 424 patients aged ≥65 years with ADHF and left ventricular ejection fraction ≤40%. Patients were divided into levosimendan and control groups. The primary outcome was in-hospital occurrence of AF, ventricular fibrillation (VF), or premature contractions (APCs/VPCs). Logistic regression identified independent risk factors for arrhythmia.   Results: After matching, 312 patients were analyzed. Arrhythmia incidence was higher in the levosimendan group (20.5%) versus control (16.7%). Levosimendan use was independently associated with increased AF risk (OR: 2.368; 95% CI: 1.022–5.487; P = 0.044). No significant link was found between levosimendan and VF or APCs/VPC. Patients with AF had longer hospital stays, though in-hospital mortality did not differ significantly across arrhythmia types.   Conclusion: Levosimendan is linked to an increased risk of AF in older ADHF patients, highlighting the need for close cardiac monitoring. Despite this association, it remains a valuable treatment option for ADHF