Control of Heart Rate Versus Rhythm in Rheumatic Atrial Fibrillation: A Randomized Study

Abstract

Maintenance of sinus rhythm is superior to ventricular rate control in patients with rheumatic atrial fibrillation with respect to effects on exercise capacity, quality of life, morbidity, and possibly mortality. Sinus rhythm could be restored in most patients, and amiodarone was superior to placebo in the restoration and maintenance of sinus rhythm.

Benefits and Risks of Long-term Amiodarone Therapy for Persistent Atrial Fibrillation: A Meta-analysis

“…[19][20][21][22][23][24][25][26][27][28][29][30] All 12 randomized controlled trials were published in English. Four trials were unblinded, 2 trials were singleblinded, and 6 trials were double-blinded.…”

Management of rheumatic atrial fibrillation

“…A small, underpowered randomised trial of rheumatic AF, using amiodarone as a rhythm control strategy, maintained sinus rhythm in 69% of patients at 1 year. (30) The poor long-term tolerability of amiodarone, and the inability to use class I antiarrhythmic drugs (like flecainide) in patients with underlying left ventricular dysfunction, often preclude the use of these drugs to maintain sinus rhythm.…”

Pharmacologic and Non-Pharmacologic Treatment of Chronic Atrial Fibrillation – With Special Reference to Valvular Atrial Fibrillation in Rheumatic Heart Disease

“…However, the maintenance of sinus rhythm is important patients receiving tissue valve replacement, or balloon intervention, because they are likely to discontinue anticoagulant therapy. If AF persists, electrical and pharmacologic cardioversion are effective in restoring sinus rhythm, and the administration of antiarrhythmic drugs may be effective in preventing www.intechopen.com Pharmacologic and Non-Pharmacologic Treatment of Chronic Atrial Fibrillation − With Special Reference to Valvular Atrial Fibrillation in Rheumatic Heart Disease 123 AF 80 . However, once AF has developed in patients with RVHD, these drugs may not be effective in restoring sinus rhythm because of the pathological changes that develop in the atrium and predispose to AF.…”