Rate Control and Sinus Rhythm Maintenance in Atrial Fibrillation

Transcatheter ablation was increasingly and successfully used to treat symptomatic drug refractory patients affected by supraventricular arrhythmias. Antiarrhythmic drug treatment still plays a major role in patient management, alone or combined with non-pharmacological therapies. Flecainide is an IC antiarrhythmic drug approved in 1984 from the Food and Drug Administration for the suppression of sustained ventricular tachycardia and later for acute cardioversion of atrial fibrillation and for sinus rhythm maintenance. Currently, flecainide is mostly used for sinus rhythm maintenance in atrial fibrillation (AF) patients without structural cardiomyopathy although recent studies enrolling different patient populations have demonstrated a good effectiveness and safety profile. How should we interpret the results of the CAST after the latest evidence? Is it possible to expand the indications of flecainide, and therefore, its use? This review aims to highlight the main characteristics of flecainide, as well as its optimal clinical use, delineating drug indications and contraindications and appropriate monitoring, based on the most recent evidence.

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Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(02)01800-4 ◽

2002 ◽

Vol 39 (9) ◽

pp. 1443-1449 ◽

Cited By ~ 81

Author(s):

Emanuele Antonielli ◽

Alfredo Pizzuti ◽

Attila Pálinkás ◽

Mattia Tanga ◽

N.oèmi Gruber ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Clinical Value ◽

Nonvalvular Atrial Fibrillation ◽

Sinus Rhythm Maintenance

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Noninvasive estimation of organization in atrial fibrillation as a predictor of sinus rhythm maintenance

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2010.12.034 ◽

2011 ◽

Vol 44 (2) ◽

pp. e11

Author(s):

Richard Petersson ◽

Frida Sandberg ◽

Pyotr Platonov ◽

Fredrik Holmqvist

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Noninvasive Estimation ◽

Sinus Rhythm Maintenance

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Comparison of Direct Current Synchronized Cardioversion to Ibutilide-Guided Catheter Ablation for Long-Term Sinus Rhythm Maintenance After Isolated Pulmonary Vein Isolation of Persistent Atrial Fibrillation

The American Journal of Cardiology ◽

10.1016/j.amjcard.2017.03.027 ◽

2017 ◽

Vol 119 (12) ◽

pp. 1997-2002 ◽

Cited By ~ 2

Author(s):

Maojing Wang ◽

Qing Zhao ◽

Wei Ding ◽

Shanglang Cai

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Sinus Rhythm ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Direct Current ◽

Persistent Atrial Fibrillation ◽

Sinus Rhythm Maintenance

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Conversion of atrial fibrillation to sinus rhythm and rate control by digoxin in comparison to placebo

European Heart Journal ◽

10.1093/oxfordjournals.eurheartj.a015310 ◽

1997 ◽

Vol 18 (4) ◽

pp. 643-648 ◽

Cited By ~ 87

Author(s):

L. Jordaens ◽

J. Trouerbach ◽

P. Calle ◽

R. Tavernier ◽

E. Derycke ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Rate Control

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Recent advances in rhythm control for atrial fibrillation

F1000Research ◽

10.12688/f1000research.11061.1 ◽

2017 ◽

Vol 6 ◽

pp. 1796 ◽

Cited By ~ 6

Author(s):

Richard Bond ◽

Brian Olshansky ◽

Paulus Kirchhof

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Sinus Rhythm ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Rate Control ◽

Rhythm Control ◽

Management Problem ◽

Recent Trial ◽

Control Therapy

Atrial fibrillation (AF) remains a difficult management problem. The restoration and maintenance of sinus rhythm—rhythm control therapy—can markedly improve symptoms and haemodynamics for patients who have paroxysmal or persistent AF, but some patients fare well with rate control alone. Sinus rhythm can be achieved with anti-arrhythmic drugs or electrical cardioversion, but the maintenance of sinus rhythm without recurrence is more challenging. Catheter ablation of the AF triggers is more effective than anti-arrhythmic drugs at maintaining sinus rhythm. Whilst pulmonary vein isolation is an effective strategy, other ablation targets are being evaluated to improve sinus rhythm maintenance, especially in patients with chronic forms of AF. Previously extensive ablation strategies have been used for patients with persistent AF, but a recent trial has shown that pulmonary vein isolation without additional ablation lesions is associated with outcomes similar to those of more extensive ablation. This has led to an increase in catheter-based technology to achieve durable pulmonary vein isolation. Furthermore, a combination of anti-arrhythmic drugs and catheter ablation seems useful to improve the effectiveness of rhythm control therapy. Two large ongoing trials evaluate whether a modern rhythm control therapy can improve prognosis in patients with AF.

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Do Restoring and Maintaining Sinus Rhythm Have a Beneficial Effect on Secondary Prevention of Stroke in Patients With Atrial Fibrillation? A Pilot Study

Angiology ◽

10.1177/0003319719856455 ◽

2019 ◽

Vol 70 (10) ◽

pp. 916-920 ◽

Cited By ~ 5

Author(s):

Cenk Conkbayir ◽

Zerrin Yigit ◽

Refika Hural ◽

Murat Ugurlucan ◽

Didem Melis Oztas ◽

...

Keyword(s):

Atrial Fibrillation ◽

Secondary Prevention ◽

Sinus Rhythm ◽

Beneficial Effect ◽

Rate Control ◽

Recurrent Stroke ◽

Rhythm Control ◽

Control Group ◽

Echocardiographic Examination ◽

Ischemic Attack

We aimed to determine whether attempts to restore and maintain sinus rhythm will reduce recurrent stroke in patients with atrial fibrillation (AF). Patients (n = 245) between March 1998 and May 2002 with AF who had an ischemic stroke including transient ischemic attack 1 to 12 months before transesophageal echocardiographic examination and had been followed for 3 years were retrospectively reviewed. Cardioversion was attempted in 130 patients; 117 (90%) patients were successfully cardioverted (rhythm control group). The 13 patients who could not be cardioverted and 115 patients who did not undergo cardioversion were assigned to the rate control group. Age, gender, ischemic heart disease, hypertension, diabetes mellitus, congestive heart failure, mitral valve disease, and left atrial diameter were similar in both groups. The rhythm control group included 56 patients (48.7%) who were still in sinus rhythm after 3 years. During follow-up, there were 2 embolic events (3.4%) and 2 deaths (3.4%) in the rhythm control group, whereas 18 embolic events (14.6%) and 18 deaths (14.6%) occurred in the rate control group ( P = .049 and P = .049, respectively). Restoration and maintenance of sinus rhythm seems to have a beneficial effect on secondary prevention of stroke in patients with AF.

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