Clinical outcomes following rhythm control for atrial fibrillation: is early better?

Kotalczyk, Agnieszka; Ding, Wern Yew; Gupta, Dhiraj; Wright, David J.; Lip, Gregory Y.H.

doi:10.1080/14779072.2021.1902307

Cited by 4 publications

(3 citation statements)

References 112 publications

(155 reference statements)

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“…In addition to a better symptom control, the concept of AF ablation as first-line treatment for AF is strongly related to quality of life which may also play an important role in all psychological aspects in the future [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Heart-Focused Anxiety, General Anxiety, Depression and Health-Related Quality of Life in Patients with Atrial Fibrillation Undergoing Pulmonary Vein Isolation

Pavlicek

Wedegärtner

Millenaar

et al. 2022

JCM

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(1) Background: Atrial fibrillation (AF) is associated with anxiety, depression, and chronic stress, and vice versa. The purpose of this study was to evaluate potential effects of pulmonary vein isolation (PVI) on psychological factors. (2) Methods: Psychological assessment was performed before PVI as well as after six months. (3) Results: A total of 118 patients [age 64 ± 9 years, 69% male, left ventricular ejection fraction 57 ± 8%, 56% paroxysmal AF] undergoing PVI were included. After PVI, significant improvements were observed in the mean total heart-focused anxiety (HFA) score, as well as in the Cardiac Anxiety Questionnaire (CAQ) sub-scores: HFA attention, HFA fear, and HFA avoidance scores. Subgroup analyses showed an association of improvement with freedom of documented AF recurrence. Mean scores of general anxiety and depression evaluated by the Hospital Anxiety and Depression Scale (HADS) decreased significantly after PVI in all subgroups regardless of AF recurrence. Further, both physical and mental composite scores of the Short Form Health Survey (SF-12) increased significantly from baseline. (4) Conclusions: PVI results in a significant reduction in HFA. Improvements in general anxiety and depressive symptoms did not seem to be related only to rhythm control per se. Therefore, CAQ may represent a more specific evaluation tool as HADS in patients with AF.

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Section: Discussionmentioning

confidence: 99%

Heart-Focused Anxiety, General Anxiety, Depression and Health-Related Quality of Life in Patients with Atrial Fibrillation Undergoing Pulmonary Vein Isolation

Pavlicek

Wedegärtner

Millenaar

et al. 2022

JCM

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“…In the full-text screenings, we further excluded 15 studies because (1) 6 studies were designed to examine the effect of early versus delayed rhythm control on adverse events in AF patients, (2), 1 study had patients with a sample size of < 100, (3), 2 studies included rhythm control strategies in the control group, and (4) 6 studies shared the same data sources with the final included studies (Supplemental Table 3). No additional studies were found in the reference lists of previous reviews [17,18]. Finally, a total of 8 studies [8,[10][11][12][19][20][21][22] (1 RCT [8], 2 post hoc analyses of RCTs [11,12], and 5 observational cohorts [10,[19][20][21][22]) were included in this meta-analysis.…”

Section: Study Identification and Selectionmentioning

confidence: 99%

Effectiveness of early rhythm control in improving clinical outcomes in patients with atrial fibrillation: a systematic review and meta-analysis

Zhu

Dong

et al. 2022

BMC Med

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Background Current guidelines recommend rhythm control for improving symptoms and quality of life in symptomatic patients with atrial fibrillation (AF). However, the long-term prognostic outcomes of rhythm control compared with rate control are still inconclusive. In this meta-analysis, we aimed to assess the effects of early rhythm control compared with rate control on clinical outcomes in newly diagnosed AF patients. Methods We systematically searched the PubMed and Embase databases up to August 2022 for randomized and observational studies reporting the associations of early rhythm control (defined as within 12 months of AF diagnosis) with effectiveness outcomes. The primary outcome was a composite of death, stroke, admission to hospital for heart failure (HF), or acute coronary syndrome (ACS). Hazard ratios (HRs) and 95% confidence intervals (CIs) from each study were pooled using a random-effects model, complemented with an inverse variance heterogeneity or quality effects model. Results A total of 8 studies involving 447,202 AF patients were included, and 23.5% of participants underwent an early rhythm-control therapy. In the pooled analysis using the random-effects model, compared with rate control, the early rhythm-control strategy was significantly associated with reductions in the primary composite outcome (HR = 0.88, 95% CI: 0.86–0.89) and secondary outcomes, including stroke or systemic embolism (HR = 0.78, 95% CI: 0.71–0.85), ischemic stroke (HR = 0.81, 95% CI: 0.69–0.94), cardiovascular death (HR = 0.83, 95% CI: 0.70–0.99), HF hospitalization (HR = 0.90, 95% CI: 0.88–0.92), and ACS (HR = 0.86, 95% CI: 0.76–0.98). Reanalyses using the inverse variance heterogeneity or quality effects model yielded similar results. Conclusions Our current meta-analysis suggested that early initiation of rhythm control treatment was associated with improved adverse effectiveness outcomes in patients who had been diagnosed with AF within 1 year. Registration The study protocol was registered to PROSPERO (CRD42021295405).

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“…Atrial fibrillation (AF) is the most common cardiac arrhythmia [1][2][3][4][5]. With increasing life expectancy, the incidence and prevalence of AF continue to rise with an estimated worldwide prevalence of 46.3 million.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Outcomes With an Early Rhythm Control Strategy in Atrial Fibrillation: A Systematic Review

et al. 2022

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In practice, atrial fibrillation (AF) is typically managed by controlling ventricular rate given similar long-term outcomes and a more tolerable drug profile when compared to rhythm control. However, despite treatment via rate control, patients remain at increased risk for cardiovascular complications. This systematic review provides a summary of literature evaluating the effectiveness of early rhythm control (ERC, initiated within 2 years of diagnosis) in AF in reducing cardiovascular complications. A systematic review utilizing the MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was performed to identify literature evaluating effectiveness of rhythm control strategies and cardiovascular complication reduction rates in ERC. A total of three literature articles meeting the inclusion and exclusion criteria were included for evaluating the benefit of ERC. One of these examined was a trial that directly compared antiarrhythmic drug (AAD) versus catheter ablation (CA) therapy in maintenance of sinus rhythm (SR). This systematic review shows that ERC is associated with a reduction of cardiovascular events in AF patients compared to other treatment strategies.

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Clinical outcomes following rhythm control for atrial fibrillation: is early better?

Cited by 4 publications

References 112 publications

Heart-Focused Anxiety, General Anxiety, Depression and Health-Related Quality of Life in Patients with Atrial Fibrillation Undergoing Pulmonary Vein Isolation

Heart-Focused Anxiety, General Anxiety, Depression and Health-Related Quality of Life in Patients with Atrial Fibrillation Undergoing Pulmonary Vein Isolation

Effectiveness of early rhythm control in improving clinical outcomes in patients with atrial fibrillation: a systematic review and meta-analysis

Cardiovascular Outcomes With an Early Rhythm Control Strategy in Atrial Fibrillation: A Systematic Review

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