Quality of Life and Exercise Performance in Patients in Sinus Rhythm Versus Persistent Atrial Fibrillation

Singh, Steven; Tang, Xiaoyin; Singh, Bramah N.; Dorian, Paul; Reda, Domenic J.; Harris, Crystal L.; Fletcher, Ross D.; Sharma, Satish C.; Atwood, J. Edwin; Jacobson, A.; Lewis, H. Daniel; Lopez, Becky; Raisch, Dennis W.; Ezekowitz, Michael D.

doi:10.1016/j.jacc.2006.03.051

Cited by 205 publications

(122 citation statements)

References 30 publications

(21 reference statements)

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“…45 Similar benefits were observed in a subsequent post-hoc analysis of quality of life and exercise performance. 46 Following on from early studies in catheter ablation in AF, a recent prospective study involving patients with CHF (n = 58) and without CHF (n = 58; ≥New York Heart Association [NYHA] Class II; left ventricular ejection fraction <45%) experienced improvements in symptoms, exercise capacity, and quality of life following the procedure (mean follow-up, 12 months). 44 The majority of patients were in sinus rhythm at the end of the follow-up period (78% of the CHF group, 84% of the control group).…”

Section: Mechanisms Of Af Development and Progressionmentioning

confidence: 99%

Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

Saliba

Wazni

2011

Clinical Cardiology

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Atrial fibrillation (AF) is a common supraventricular tachyarrhythmia with substantial morbidity and mortality. This review briefly describes the mechanisms of AF development and progression, including electrical, structural, and contractile remodeling. In addition, the potential benefits of achieving and maintaining sinus rhythm are discussed. For example, rhythm control has been associated with improvements in left ventricular function, AF symptoms, exercise tolerance, the ability to perform activities of daily living, and quality of life. More recently, dronedarone, a noniodinated benzofuran derivative approved for use in the treatment of AF, was shown to significantly improve clinical outcomes including cardiovascular hospitalizations and death from any cause in A Placebo‐Controlled, Double‐Blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg bid for the Prevention of Cardiovascular Hospitalization or Death From Any Cause in Patients With Atrial Fibrillation/Atrial Flutter (ATHENA). The review concludes with an examination of AF treatment options and expectations. Evidence suggests that the complete absence of AF recurrence is not always achievable; however, complete restoration of sinus rhythm may not be necessary for patients to achieve clinically meaningful benefits. Copyright © 2011 Wiley Periodicals, Inc.The editorial assistance provided for this manuscript was funded by Sanofi‐Aventis. The authors were fully responsible for all content and editorial decision, and received no financial support or other form of compensation related to the development of the paper. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

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Section: Mechanisms Of Af Development and Progressionmentioning

confidence: 99%

Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

Saliba

Wazni

2011

Clinical Cardiology

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“…In patients with paroxysmal AF, prevention of AF recurrence and conversion to the chronic form are expected to result in improvement not only in subjective symptoms but also in QOL through the amelioration of exercise tolerance. 26,27) Also, in a previous prospective study of patients with paroxysmal AF in Japan (J-RHYTHM Study), rhythm control therapy was shown to be superior to rate control therapy in terms of efficacy on soft endpoints (including psychological disability requiring alternation of treatment strategy). 28) Because antiarrhythmic drug therapy exerted better prophylactic efficacy in patients with first detected AF, whose subjective symptoms tend to be more intense and reduction in QOL is greater, rhythm control therapy aimed at maintaining sinus rhythm seems to be a desirable strategy for these patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Profiles, Efficacy of Antiarrhythmic Drug Therapy, and Cardiovascular Prognosis in Patients With First Detected Paroxysmal Atrial Fibrillation

et al. 2011

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SummaryLittle information is available concerning clinical profiles and outcomes of treatment in Japanese patients with first detected atrial fibrillation (AF). In the present study, 459 patients with paroxysmal AF (309 males, mean age, 66 ± 12 years) were divided into a first detected AF group (group A, n = 143) and a non-first detected AF group (group B, n = 316). Clinical profiles, prophylactic efficacy of antiarrhythmic drug therapy (AAD), and cardiovascular prognosis during a mean follow-up period of 50 ± 35 months were compared between the two groups. The number of AF recurrences in the individual patients regardless of AAD were significantly lower in group A than in group B (0.8 ± 1.4 versus 1.7 ± 1.9) (P < 0.05). The percentages of patients free from conversion to chronic AF at 12, 36, 60, and 120 months were significantly higher in group A (98%, 96%, 93%, and 91%, respectively) than in group B (95%, 86%, 83%, and 79%, respectively)(P < 0.01). The annual rates of hospitalization for thromboembolism, heart failure, and cardiovascular death did not differ between group A (2.2%, 1.1% and 1.0%, respectively) and group B (2.2%, 1.9% and 1.1%, respectively). In multivariate logistic regression analysis, a CHADS 2 score ≥ 2 points (odds ratio 13.1, 95% confidence interval 3.36-51.0, P = 0.001), nocturnal AF onset (OR 0.201, 95% CI 0.050-0.815, P = 0.025), left ventricular diastolic dimension (LVDd) ≥ 50 mm (OR 3.845, 95% CI 1.078-13.71, P = 0.038), and conversion to chronic AF (OR 3.547, 95% CI 1.002-13.64, P = 0.048) were associated with cardiovascular events in group A. Rhythm control therapy with antiarrhythmic drugs was shown to be more effective for patients in group A than in group B. It is particularly important to prevent cardiovascular events in first detected AF patients with a CHADS 2 score ≥ 2 points, LVDd ≥ 50 mm, and conversion to chronic AF. (Int Heart J 2011; 52: 32-38)

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“…The clinical benefits of restoration and maintenance of SR in patients with persistent AF, including improvements in quality of life and functional capacity, as well as reduced morbidity and mortality, have been widely reported [1,2,[12][13][14][15][16]. Diverse pharmacologic strategies directed toward long-term preservation of normal SR after reversion of persistent AF have been proposed, with modest antiarrhythmic efficacy and the incidence of limiting and even harmful adverse effects [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…It occurs in about 2-3% of the general population over 60 years of age, and in nearly 10% of individuals above 80 years. Long-term prevention of arrhythmia relapses reduces morbidity and improves quality of life and exercise capacity [1,2]. Therefore, restoration of normal sinus rhythm (SR) is usually attempted in patients with persistent AF, either by pharmacological or electrical means [3].…”

Section: Introductionmentioning

confidence: 99%

Short-term amiodarone therapy after reversion of persistent atrial fibrillation reduces recurrences at 18 months

et al. 2014

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Quality of Life and Exercise Performance in Patients in Sinus Rhythm Versus Persistent Atrial Fibrillation

Abstract: In patients with persistent AF, restoration and maintenance of SR was associated with improvements in QOL measures and EP. There was a strong correlation between QOL measures and EP.

Cited by 205 publications

References 30 publications

Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials

Clinical Profiles, Efficacy of Antiarrhythmic Drug Therapy, and Cardiovascular Prognosis in Patients With First Detected Paroxysmal Atrial Fibrillation

Short-term amiodarone therapy after reversion of persistent atrial fibrillation reduces recurrences at 18 months

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