scholarly journals Rhythm control treatment strategies for atrial fibrillation: current consensus and future possibilities

2020 ◽  
Vol 20 (Suppl 2) ◽  
pp. s4-s5
Author(s):  
Ahmed Alsunbuli
Keyword(s):  
Atrial Fibrillation ◽  
Treatment Strategies ◽  
Rhythm Control ◽  
Control Treatment

scholarly journals Women and Atrial Fibrillation

2020 ◽  
Author(s):  
ANNABELLE VOLGMAN ◽  
Emelia Benjamin ◽  
Anne Curtis ◽  
Margaret Fang ◽  
Kathryn Lindley ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Control Strategies ◽  
Management Strategies ◽  
Treatment Strategies ◽  
The United States ◽  
Evidence Base ◽  
Rhythm Control ◽  
Control Treatment ◽  
Increased Risk ◽  
Control Management

Atrial fibrillation (AF) remains a growing problem in the United States and worldwide, imposing a high individual and health system burden, including increased resource consumption due to repeated hospitalizations, stroke, dementia, heart failure, and death. This comprehensive review summarizes the most recent data on sex-related differences in risks associated with AF. Women with AF have increased risk of stroke and death compared to men, and possible reasons for this disparity are explored. Women also continue to have worse symptoms and quality of life, and poorer outcomes with stroke prevention, as well as with rate and rhythm control management strategies. Many current rhythm control treatment strategies for AF, including cardioversion and ablation, are used less frequently in women as compared to men, whereas women are more likely to be treated with rate control strategies or anti-arrhythmic drugs. Sex differences should be considered in treating women with AF to improve outcomes and women and men should be offered the same interventions for AF. We need to improve the evidence base to understand if variation in utilization of rate and rhythm control management between men and women represents health inequities or appropriate clinical judgement.

scholarly journals Gender-Related Differences In Treatment Patterns And Outcomes of Patients With Atrial Fibrillation: Insights From The MISOAC-AF Trial

2021 ◽  
Author(s):  
Ioannis Vouloagkas ◽  
Anastasios Kartas ◽  
Athanasios Samaras ◽  
Andreas S. Papazoglou ◽  
Dimitrios V. Moysidis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Rate Control ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Treatment Patterns ◽  
Rhythm Control ◽  
Vitamin K Antagonist ◽  
Control Treatment ◽  
All Cause Mortality

Abstract PurposeTo assess the gender-related differences in the treatment patterns of patients with atrial fibrillation (AF), and their prognostic value.MethodsIn this post-hoc analysis of a randomized controlled trial, 1140 hospitalized patients with comorbid AF were followed-up for a median of 2.6 years. Kaplan-Meier and multivariable Cox-regression analyses assessed the adjusted hazard ratios (aHRs) for outcomes in males and females, according to oral anticoagulation (OAC) type (vitamin K antagonist or non-vitamin K antagonist oral anticoagulants), rhythm or rate control treatment. The primary outcome was all-cause mortality and the secondary outcomes were stroke and the composite of any hospitalization or cardiovascular death. ResultsAmong 622 males and 518 females, use of OAC (61% vs 62%), rate control (56% vs 57%), and rhythm control (31% vs 28%) treatments was similar (all p>0.05). In males, use of rate control, as compared with rhythm control, was independently associated with higher rates of all-cause mortality (aHR=2.06; 95% confidence interval [CI] 1.24-3.41) and the composite of hospitalization or cardiovascular death (aHR=1.34, 95% CI 1.01-1.85). In females, use of rhythm control was significantly associated with higher rates of hospitalization-or cardiovascular mortality (aHR=1.74, 95% CI 1.03-2.94). Among genders, stroke rates were similar regardless of OAC type, rate or rhythm control treatment.ConclusionsIn patients discharged from the hospital with comorbid AF, the use of OAC, rhythm or rate control treatment was similar among genders. However, males seemed to benefit more from rhythm, whereas females from rate control treatment.

Features of the management of patients with atrial fibrillation during the covid-19 pandemic: current questions and possible answers

2021 ◽  
Vol 23 (1) ◽  
pp. 32-34
Author(s):  
Dmitry A. Napalkov ◽  
◽  
Anastasiya A. Sokolova ◽  
Alena I. Skripka ◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Treatment Strategies ◽  
Rhythm Control ◽  
Thromboembolic Events ◽  
Prevention Of Thromboembolic Events ◽  
Key Issues ◽  
Coronavirus Infection

This publication is devoted to the tactics of management of patients with atrial fibrillation during the pandemic of new coronavirus infection (COVID-19). Among the key issues of relevance during this period, we thought it possible to consider the epidemiology, prevalence, and pathophysiological mechanisms of atrial fibrillation in patients with COVID-19, as well as treatment strategies with regard to obvious hospitalization, rhythm control/restoration and prevention of thromboembolic events. A separate issue is the tactics regarding the prescription or continuation of therapy aimed at the prevention of thromboembolic events and possible drug interactions in patients treated for COVID-19 and receiving anticoagulant therapy with direct oral anticoagulants for atrial fibrillation. Keywords: atrial fibrillation, COVID-19, thromboembolic events, anticoagulant therapy For citation: Napalkov DA, Sokolova AA, Skripka AI. Features of the management of patients with atrial fibrillation during the COVID-19 pandemic: current questions and possible answers, Consilium Medicum. 2021; 23 (1): 32–34. DOI: 10.26442/20751753.2021.1.200669

scholarly journals Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan database

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vinita Subramanya ◽  
J’Neka S. Claxton ◽  
Pamela L. Lutsey ◽  
Richard F. MacLehose ◽  
Lin Y. Chen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Rate Control ◽  
Treatment Strategy ◽  
Cox Regression ◽  
Rhythm Control ◽  
Adverse Outcomes ◽  
Control Treatment ◽  
To Receive

Abstract Background Women with atrial fibrillation (AF) experience greater symptomatology, worse quality of life, and have a higher risk of stroke as compared to men, but are less likely to receive rhythm control treatment. Whether these differences exist in elderly patients with AF, and whether sex modifies the effectiveness of rhythm versus rate control therapy has not been assessed. Methods We studied 135,850 men and 139,767 women aged ≥ 75 years diagnosed with AF in the MarketScan Medicare database between 2007 and 2015. Anticoagulant use was defined as use of warfarin or a direct oral anticoagulant. Rate control was defined as use of rate control medication or atrioventricular node ablation. Rhythm control was defined by use of anti-arrhythmic medication, catheter ablation or cardioversion. We used multivariable Poisson and Cox regression models to estimate the association of sex with treatment strategy and to determine whether the association of treatment strategy with adverse outcomes (bleeding, heart failure and stroke) differed by sex. Results At the time of AF, women were on average (SD) 83.8 (5.6) years old and men 82.5 (5.2) years, respectively. Compared to men, women were less likely to receive an anticoagulant or rhythm control treatment. Rhythm control (vs. rate) was associated with a greater risk for heart failure with a significantly stronger association in women (HR women = 1.41, 95% CI 1.34–1.49; HR men = 1.21, 95% CI 1.15–1.28, p < 0.0001 for interaction). No sex differences were observed for the association of treatment strategy with the risk of bleeding or stroke. Conclusion Sex differences exist in the treatment of AF among patients aged 75 years and older. Women are less likely to receive an anticoagulant and rhythm control treatment. Women were also at a greater risk of experiencing heart failure as compared to men, when treated with rhythm control strategies for AF. Efforts are needed to enhance use AF therapies among women. Future studies will need to delve into the mechanisms underlying these differences.

scholarly journals Comparative Effectiveness of Early Rhythm Control Versus Rate Control for Cardiovascular Outcomes in Patients With Atrial Fibrillation

2021 ◽  
Author(s):  
Daehoon Kim ◽  
Pil‐Sung Yang ◽  
Seng Chan You ◽  
Eunsun Jang ◽  
Hee Tae Yu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Rate Control ◽  
Cardiovascular Death ◽  
Population Based ◽  
Cardiovascular Outcomes ◽  
Rhythm Control ◽  
Control Treatment ◽  
Control Rhythm

Background Rhythm control is associated with better cardiovascular outcomes than usual care among patients with recently diagnosed atrial fibrillation (AF). This study investigated the effects of rhythm control compared with rate control on the incidence of stroke, heart failure, myocardial infarction, and cardiovascular death stratified by timing of treatment initiation. Methods and Results We conducted a retrospective population‐based cohort study including 22 635 patients with AF newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control in 2011 to 2015 from the Korean National Health Insurance Service database. Propensity overlap weighting was used. Compared with rate control, rhythm control initiated within 1 year of AF diagnosis decreased the risk of stroke. The point estimates for rhythm control initiated at selected time points after AF diagnosis are as follows: 6 months (hazard ratio [HR], 0.76; 95% CI, 0.66–0.87), 1 year (HR, 0.78; 95% CI, 0.66–0.93), and 5 years (HR, 1.00; 95% CI, 0.45–2.24). The initiation of rhythm control within 6 months of AF diagnosis reduced the risk of hospitalization for heart failure: 6 months (HR, 0.84; 95% CI, 0.74–0.95), 1 year (HR, 0.96; 95% CI, 0.82–1.13), and 5 years (HR, 2.88; 95% CI, 1.34–6.17). The risks of myocardial infarction and cardiovascular death did not differ between rhythm and rate control regardless of treatment timing. Conclusions Early initiation of rhythm control was associated with a lower risk of stroke and heart failure–related admission than rate control in patients with recently diagnosed AF. The effects were attenuated as initiating the rhythm control treatment later.

scholarly journals Mechanisms of Atrial Fibrillation and Their Impact on Strategies for Catheter Ablation

2018 ◽  
Vol 4 (2) ◽  
pp. 56 ◽  
Author(s):  
Norbert Guettler ◽  
Edward Nicol ◽  
Joern Schmitt ◽  
Kim Rajappan ◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Low Voltage ◽  
Treatment Strategies ◽  
Surrogate Marker ◽  
Rhythm Control ◽  
Resonance Imaging ◽  
Substrate Modification ◽  
Underlying Mechanisms ◽  
Randomised Controlled

Atrial fibrillation (AF) is the most common sustained arrhythmia, and is ubiquitous in clinical practice. The underlying mechanisms of initiation and maintenance of AF are complex and not completely understood. This knowledge, however, is fundamental for the development of treatment strategies for AF. Within the last 20 years, catheter ablation has played an increasing role as a rhythm control therapy. Based on diverse models for the initiation and maintenance of AF, various ablation strategies have been proposed. The cornerstone of AF ablation has been pulmonary vein isolation (PVI). In persistent AF, however, PVI alone is often not sufficient. This may be because of the structural remodelling of the atria leading to dilation and fibrosis amongst other factors. The optimal strategy for substrate modification, however, is still a matter of investigation. Current studies are concentrating on the ablation of fibrotic areas, especially in the left atrium, either detected by delayed enhancement magnetic resonance imaging or by identification of low-voltage areas as a surrogate marker. The second intensely evaluated strategy is the localisation and ablation of rotational activity. Many further randomised controlled trials will likely be needed to determine the optimal ablation strategy for individual patients.

scholarly journals Current Drug Treatment Strategies for Atrial Fibrillation and TASK-1 Inhibition as an Emerging Novel Therapy Option

2021 ◽  
Vol 12 ◽  
Author(s):  
Manuel Kraft ◽  
Antonius Büscher ◽  
Felix Wiedmann ◽  
Yannick L’hoste ◽  
Walter E. Haefeli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Rate Control ◽  
Antiarrhythmic Drugs ◽  
Heart Diseases ◽  
Pulmonary Veins ◽  
Treatment Strategies ◽  
Rhythm Control ◽  
Electrical Cardioversion ◽  
Adequate Treatment

Atrial fibrillation (AF) is the most common sustained arrhythmia with a prevalence of up to 4% and an upwards trend due to demographic changes. It is associated with an increase in mortality and stroke incidences. While stroke risk can be significantly reduced through anticoagulant therapy, adequate treatment of other AF related symptoms remains an unmet medical need in many cases. Two main treatment strategies are available: rate control that modulates ventricular heart rate and prevents tachymyopathy as well as rhythm control that aims to restore and sustain sinus rhythm. Rate control can be achieved through drugs or ablation of the atrioventricular node, rendering the patient pacemaker-dependent. For rhythm control electrical cardioversion and pharmacological cardioversion can be used. While electrical cardioversion requires fasting and sedation of the patient, antiarrhythmic drugs have other limitations. Most antiarrhythmic drugs carry a risk for pro-arrhythmic effects and are contraindicated in patients with structural heart diseases. Furthermore, catheter ablation of pulmonary veins can be performed with its risk of intraprocedural complications and varying success. In recent years TASK-1 has been introduced as a new target for AF therapy. Upregulation of TASK-1 in AF patients contributes to prolongation of the action potential duration. In a porcine model of AF, TASK-1 inhibition by gene therapy or pharmacological compounds induced cardioversion to sinus rhythm. The DOxapram Conversion TO Sinus rhythm (DOCTOS)-Trial will reveal whether doxapram, a potent TASK-1 inhibitor, can be used for acute cardioversion of persistent and paroxysmal AF in patients, potentially leading to a new treatment option for AF.

scholarly journals Atrial fibrillation in patients with an atrial septal defect in a single centre cohort during a long clinical follow-up: its association with closure and outcome of therapy

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001298
Author(s):  
Reinder Evertz ◽  
Manon Reinders ◽  
Charlotte Houck ◽  
Tim ten Cate ◽  
Anthonie L. Duijnhouwer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Treatment Success ◽  
Treatment Strategies ◽  
Rhythm Control ◽  
Single Centre ◽  
Closure Method ◽  
Clear Relation

ObjectiveCurrently, consensus is lacking on the relation between closure of atrial septal defect (ASD) and the incidence of atrial fibrillation (AF), which is a known complication in ASD patients. More importantly, studies reporting on the treatment applied for AF in ASD patients are scarce. The aims of this study were (1) to assess the incidence of AF in ASD patients, (2) to study the relation between closure and AF and (3) to evaluate applied treatment strategies.MethodsA single-centre retrospective study in 173 patients with an ASD was performed. We analysed the incidence of AF, the relation of AF with closure, method of closure and the treatment success of therapies applied.ResultsAlmost 20% of patients with an ASD developed AF, with a mean age of 59 (±14) years at first presentation of AF during a median clinical follow-up of 43 (29–59) years. Older age (OR 1.072; p<0.001) and a dilated left atrium (OR 3.727; p=0.009) were independently associated with new-onset AF. Closure itself was not independently associated with AF. First applied treatment strategy was rhythm control in 77%. Of the 18 patients treated with antiarrhythmic drugs 50% had at least 1 recurrence of AF.ConclusionNo clear relation between closure of the ASD and AF could be assessed. This is the first study describing applied therapy for AF in ASD patients of which medical rhythm control was the most applied strategy with a disappointing efficacy.

scholarly journals Sex Differences in Treatment Strategy and Adverse Outcomes Among Patients 75 and Older With Atrial Fibrillation in the MarketScan Database

2021 ◽  
Author(s):  
Vinita Subramanya ◽  
J’Neka S. Claxton ◽  
Pamela L. Lutsey ◽  
Richard F. MacLehose ◽  
Lin Y. Chen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Rate Control ◽  
Treatment Strategy ◽  
Cox Regression ◽  
Rhythm Control ◽  
Adverse Outcomes ◽  
Control Treatment ◽  
To Receive

Abstract Background: Women with atrial fibrillation (AF) experience greater symptomatology, worse quality of life, and have a higher risk of stroke as compared to men, but are less likely to receive rhythm control treatment. Whether these differences exist in elderly patients with AF, and whether sex modifies the effectiveness of rhythm versus rate control therapy has not been assessed.Methods: We studied 135,850 men and 139,767 women aged ≥75 years diagnosed with AF in the MarketScan Medicare database between 2007-2015. Anticoagulant use was defined as use of warfarin or a direct oral anticoagulant. Rate control was defined as use of rate control medication or atrioventricular node ablation. Rhythm control was defined by use of anti-arrhythmic medication, catheter ablation or cardioversion. We used multivariable Poisson and Cox regression models to estimate the association of sex with treatment strategy and to determine whether the association of treatment strategy with adverse outcomes (bleeding, heart failure and stroke) differed by sex. Results: At the time of AF, women were on average (SD) 83.8 (5.6) years old and men 82.5 (5.2) years, respectively. Compared to men, women were less likely to receive an anticoagulant or rhythm control treatment. Rhythm control (vs. rate) was associated with a greater risk for heart failure with a significantly stronger association in women (HR women = 1.41, 95%CI 1.34-1.49; HR men= 1.21, 95%CI 1.15-1.28, p <0.0001 for interaction). No sex differences were observed for the association of treatment strategy with the risk of bleeding or stroke. Conclusion: Sex differences exist in the treatment of AF among patients aged 75 years and older. Women are less likely to receive an anticoagulant and rhythm control treatment. Women were also at a greater risk of experiencing heart failure as compared to men, when treated with rhythm control strategies for AF. Efforts are needed to enhance use AF therapies among women. Future studies will need to delve into the mechanisms underlying these differences.

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