Rhythm control better prevents stroke and mortality than rate control strategies in patients with atrial fibrillation - A nationwide cohort study

2018 ◽  
Vol 270 ◽  
pp. 154-159 ◽  
Author(s):  
Chi-Jen Weng ◽  
Cheng-Hung Li ◽  
Ying-Chieh Liao ◽  
Che-Chen Lin ◽  
Jiunn-Cherng Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Rate Control ◽  
Control Strategies ◽  
Rhythm Control

scholarly journals Management strategies for atrial fibrillation and flutter in patients with transthyretin cardiac amyloidosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Z Dale ◽  
P Chandrashekar ◽  
L Al-Rashdan ◽  
M Kim ◽  
A Masri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Rate Control ◽  
Cardiac Amyloidosis ◽  
Control Strategies ◽  
Nyha Class ◽  
Management Strategies ◽  
Symptomatic Improvement ◽  
Rhythm Control ◽  
Ventricular Rate ◽  
Ventricular Response

Abstract Background Atrial fibrillation (AF) and flutter (AFL) are common in transthyretin cardiac amyloidosis (ATTR-CM). Ventricular rate control drugs in ATTR-CM are poorly tolerated but data addressing tolerability and efficacy of rhythm control strategies is limited. Purpose We report characteristics and outcomes of AF/AFL in a cohort with ATTR-CM. Methods A single center observational study of patients seen at our Amyloidosis Center with wild-type or hereditary ATTR-CM diagnosed between 2005–2019. Treatment was prescribed as per treating cardiologists. Results Eighty-four patients with ATTR-CM (average age 74±10 years, 94% male) had mean follow-up of 27.6±22.8 months. AF/AFL occurred in 61 patients (73%). Clinically significant rapid ventricular response (RVR) was common as well attempted rate control with AV node blockers (Table 1). However, discontinuation was frequent (80%), often for adverse effects of hypotension (33%), bradycardia (15%), or presyncope/syncope (10%). Rhythm control was initiated in 64%, most often with cardioversion (DCCV) or ablation (Table 2). Post-DCCV recurrence was common (91%) and time to recurrence did not differ with use of anti-arrhythmic drugs (AAD; 5.8 months (IQR 1.9–12.5) vs without AAD 6.2 months (IQR 1.9–12.5) p=0.83). TEE was performed for 33% of DCCV with thrombus seen in 11% of cases – all patients who were not anticoagulated at the time. TEE was otherwise deferred due to known AF/AFL duration <48 hours (13%) or adequate anticoagulation (54%). Ablation was performed in 23% of patients with AFL (all for typical AFL) with 2 patients (14%) having recurrence after mean of 60.9 months. Pulmonary vein isolation for AF was performed in 12% (86% for persistent AF) with 86% recurrence after median of 6.2 months (IQR 5.6–12.3). Most patients (62%) with rhythm control had subjective improvement (≥1 NYHA class or resolved palpitations). Among AAD, amiodarone was most well tolerated with only 8% of patient discontinuing due to side effects. DCCV and ablation resulted in no direct complications although one patient had a perforation of a previously unknown Zenker diverticulum during TEE pre-DCCV. Conclusions In our ATTR-CM cohort, AF/AFL was common. Rate control was poorly tolerated and often abandoned. While rhythm control of AF/AFL had a favorable safety profile and successful conversion to sinus rhythm led to symptomatic improvement in a majority of cases, durable success with rhythm control was limited, often requiring multiple therapies. DCCV is only modestly successful and not significant improved with AAD. Ablation was successful in cases of cavo-tricuspid isthmus dependent AFL but had limited success in AF. FUNDunding Acknowledgement Type of funding sources: None.

Atrial Fibrillation and Congestive Heart Failure: A Cost Analysis of Rhythm-Control vs Rate-Control Strategies

2013 ◽  
Vol 29 (10) ◽  
pp. 1256-1262 ◽  
Author(s):  
Frédéric Poulin ◽  
Paul Khairy ◽  
Denis Roy ◽  
Sylvie Levesque ◽  
Mario Talajic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Cost Analysis ◽  
Rate Control ◽  
Control Strategies ◽  
Rhythm Control

scholarly journals Rate-control versus Rhythm-control Strategies and Outcomes in Septuagenarians with Atrial Fibrillation

2013 ◽  
Vol 126 (10) ◽  
pp. 887-893 ◽  
Author(s):  
Nasir Shariff ◽  
Ravi V. Desai ◽  
Kanan Patel ◽  
Mustafa I. Ahmed ◽  
Gregg C. Fonarow ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Rate Control ◽  
Control Strategies ◽  
Rhythm Control ◽  
Control Versus

scholarly journals Rhythm Versus Rate Control for Atrial Fibrillation: A Meta-analysis of Randomized Controlled Trials

2018 ◽  
Vol 11 (2) ◽  
pp. 609-620 ◽  
Author(s):  
Abdelrahman Ibrahim Abushouk ◽  
Aya Ashraf Ali ◽  
Ahmed Abdou Mohamed ◽  
Loalo'a El-Sherif ◽  
Mennat-Allah Abdelsamed ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Rate Control ◽  
Control Strategies ◽  
Meta Analysis ◽  
Rhythm Control ◽  
Control Group ◽  
Effect Estimate ◽  
Increased Risk ◽  
All Cause Mortality

Atrial fibrillation (AF) is a common, sustained tachyarrhythmia, associated with an increased risk of mortality and thromboembolic events. We performed this meta-analysis to compare the clinical efficacy of rate and rhythm control strategies in patients with AF in a meta-analysis framework. A comprehensive search of PubMed, OVID, Cochrane-CENTRAL, EMBASE, Scopus, and Web of Science was conducted, using relevant keywords. Dichotomous data on mortality and other clinical events were extracted and pooled as risk ratios (RRs), with their 95% confidence-interval (CI), using RevMan software (version 5.3). Twelve studies (8451 patients) were pooled in the final analysis. The overall effect-estimate did not favor rate or rhythm control strategies in terms of all-cause mortality (RR= 1.13, 95% CI [0.88, 1.45]), stroke (RR= 0.97, 95% CI [0.79, 1.20]), thromboembolism (RR= 1.06, 95% CI [0.64, 1.76]), and major bleeding (RR= 1.10, 95% CI [0.90, 1.35]) rates. These findings were consistent in AF patients with concomitant heart failure (HF). The rate of rehospitalization was significantly higher (RR= 0.72, 95% CI [0.57, 0.92]) in the rhythm control group, compared to the rate control group. In younger patients (<65 years), rhythm control was superior to rate control in terms of lowering the risk of all-cause mortality (p=0.0003), HF (p=0.003) and major bleeding (p=0.02). In older AF patients and those with concomitant HF, both rate and rhythm control strategies have similar rates of mortality and major clinical outcomes; therefore, choosing an appropriate strategy should consider individual variations, such as patient preferences, comorbidities, and treatment cost.

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