Rate vs. Rhythm Control in Patients With Atrial Fibrillation. A Meta-Analysis

Denus, Simon de; Sanoski, Cynthia A.; Carlsson, J.; Opolski, Grzegorz; Spinler, Sarah A.

doi:10.1016/j.accreview.2005.05.063

Cited by 50 publications

(71 citation statements)

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“…Whereas AFFIRM and HOT CAFÉ hinted at a benefit of the rate-control over the rhythm-control strategy, STAF showed an opposite trend and PIAF and RACE showed no difference ( Table 2). A meta-analysis of the first five trials that included 5,239 patients with a mean age of 69 years found no differences in all-cause mortality and incidence of ischemic strokes between the rate-and rhythm-control strategies [76]. This apparent lack of mortality benefit with the rhythm-control strategy was likely due to the suboptimal efficacy in maintaining sinus rhythm and the extensive side effect profile of antiarrhythmic drugs.…”

Section: Pharmacological Treatment Of Af In the Elderlymentioning

confidence: 89%

Atrial fibrillation and heart failure in the elderly

2011

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Atrial fibrillation (AF) is a common clinical problem in elderly patients and especially in those with heart failure (HF). It is a major risk factor for serious cardiovascular events, such as stroke, HF and premature death. Both the prevalence and incidence of AF increase with age and its prevalence in the United States are estimated at more than 2.2 million, with nearly 75% of patients aged >65 years. Aging-related atrial remodeling with fibrosis, dilation and mitochondrial DNA mutations predispose elderly patients to AF. Current management options for AF, including rate control and anticoagulation therapy, can be successfully applied to the elderly population. New antiarrhythmic and anticoagulation medications such as dronedarone and dabigatran, respectively, can impact the approach to therapy in the elderly. Non-pharmacological options such as catheter-based ablation have also gained prominence and have been incorporated into the guidelines for management of AF. However, more trials in the elderly and very elderly segments are needed to clarify the safety and long-term efficacy of the new treatment options.

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Section: Pharmacological Treatment Of Af In the Elderlymentioning

confidence: 89%

Atrial fibrillation and heart failure in the elderly

2011

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“…Three of 4 meta-analyses showed similar thromboembolic outcomes between the rate and rhythm control strategies (total 13,760 patient-years in 5 trials), whereas 1 metaanalysis showed that rate control strategy was associated with a strikingly lower risk of thromboembolic stroke (total 215,467 patient-years in 8 trials). [23][24][25][26] In 1 large populationbased observational study, compared with rate control therapy, rhythm control therapy was associated with lower rates of stroke/transient ischemic attack among AF patients, particularly among those with CHAD 2 score of 1 at maximum 8.2 years of follow-up (total 115,340 patientyears). 27 We propose several reasons to explain why we obtained different results from other studies.…”

Section: Propafenone and Strokementioning

confidence: 97%

Factors predisposing to ventricular proarrhythmia during antiarrhythmic drug therapy for atrial fibrillation in patients with structurally normal heart

Lin

Chen

et al. 2015

Heart Rhythm

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“…They can usually be discharged within 24 h of complete evaluation and after a marked reduction in anxiety levels linked to symptoms both induced by arrhythmias and possibly by self-treatment. Lastly, we must keep in mind that the optimal treatment of AF remains controversial: [10][11][12][13][14][15][16] i.e. restoring the normal sinus rhythm or controlling the ventricular rate are the two main intervention choices.…”

Section: Discussionmentioning

confidence: 99%

Controversies in the “pill in the pocket” approach to atrial fibrillation

Riccardi

Lerza

2008

Intern Emerg Med

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The efficacy of class I antiarrhythmic drugs in terminating atrial fibrillation (AF) has been proven. Both intravenous and oral administration of propafenone and flecainide restore sinus rhythm in a high percentage of cases [1][2][3][4][5]. Furthermore, in selected patients, the possibility of home self-administration of one of these drugs has been studied and is deemed safe for treating the sudden onset of heart palpitations [6]. Indeed, the recurrence of AF is responsible for a number of emergency department (ED) visits and hospital admissions. The ''pill in the pocket'' approach has proven to be effective in reducing this phenomenon. We report two cases we observed at our ED which could be the launching pad for both discussion and criticism about the ''pill in the pocket'' approach that is receiving increasing attention and ever-growing application in Italy. Case reportsCase 1 A 65-year-old man was admitted to our observation ward because of palpitations that had been going on for 6 h. He had a history of mild hypertension, treated with atenolol 100 mg and hydrochlorothiazide 12.5 mg. Over the last 2 years he had been hospitalized twice because of two episodes of AF which had required cardioversion with propafenone. During these previous admissions, severe cardiomyopathy, left ventricular dysfunction, severe valvular heart disease, and arrhythmic episodes other than atrial fibrillation had been ruled out. Two hours before being admitted to our ED he had taken 600 mg of propafenone as recommended, but after taking the medication his symptoms worsened. Blood pressure and physical examination were normal. Routine biochemical laboratory tests were normal as well. Electrocardiogram (ECG) showed a sinus rhythm with a variable heart rate (45-90 bpm) and a previously existing incomplete left bundle branch block, but transient sinus atrial blocks. The patient was monitored in the ED because he was symptomatic for pre-syncope. One hour after admission his ECG showed sinus arrest with a prolonged asystole (Fig. 1). The patient regained normal sinus rhythm after 24 h of complete drug wash-out. He was discharged after 48 h and sent to a cardiologist for a consult.Case 2 A 70-year-old woman with a history of hypertension, who was being treated with atenolol 50 mg, was brought to our ED because of palpitations. She realized that it could have been high rate AF because she had already had two previous transient episodes of arrhythmias, the first of which was treated by electrical cardioversion, and a second one which was treated by intravenous propafenone. Severe cardiomyopathy had been ruled out, and the physicians had advised the patient to take 425 mg of propafenone if AF recurred. She was also being treated with recommended dose of warfarin. Therefore, she had immediately taken this oral dose of propafenone, but nonetheless, she required medical evaluation in our ED. AF with a heart rate of approximately 200 bpm was observed at admission, but the patient showed no clinical signs of heart failure or any chest pain. Laborat...

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Rate vs. Rhythm Control in Patients With Atrial Fibrillation. A Meta-Analysis

Cited by 50 publications

References 0 publications

Atrial fibrillation and heart failure in the elderly

Atrial fibrillation and heart failure in the elderly

Factors predisposing to ventricular proarrhythmia during antiarrhythmic drug therapy for atrial fibrillation in patients with structurally normal heart

Controversies in the “pill in the pocket” approach to atrial fibrillation

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