Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation

Abstract

Recent innovations have the potential to improve rhythm control therapy in patients with atrial fibrillation (AF). Controlled trials provide new evidence on the effectiveness and safety of rhythm control therapy, particularly in patients with AF and heart failure. This review summarizes evidence supporting the use of rhythm control therapy in patients with AF for different outcomes, discusses implications for indications, and highlights remaining clinical gaps in evidence. Rhythm control therapy improves symptoms and quality of life in patients with symptomatic AF and can be safely delivered in elderly patients with comorbidities (mean age 70 years, 3–7% complications at 1 year). Atrial fibrillation ablation maintains sinus rhythm more effectively than antiarrhythmic drug therapy, but recurrent AF remains common, highlighting the need for better patient selection (precision medicine). Antiarrhythmic drugs remain effective after AF ablation, underpinning the synergistic mechanisms of action of AF ablation and antiarrhythmic drugs. Atrial fibrillation ablation appears to improve left ventricular function in a subset of patients with AF and heart failure. Data on the prognostic effect of rhythm control therapy are heterogeneous without a clear signal for either benefit or harm. Rhythm control therapy has acceptable safety and improves quality of life in patients with symptomatic AF, including in elderly populations with stroke risk factors. There is a clinical need to better stratify patients for rhythm control therapy. Further studies are needed to determine whether rhythm control therapy, and particularly AF ablation, improves left ventricular function and reduces AF-related complications.

Early Rhythm-Control Therapy in Patients with Atrial Fibrillation

“…Early Rhythm-Control Therapy in Patients with Atrial Fibrillation ven with current guideline-based management, patients with atrial fibrillation have stroke, acute coronary syndrome, heart failure, and cardiovascular death at a rate of approximately 5% of patients per year, [1][2][3][4] and 35 to 50% of patients with atrial fibrillation who receive adequate anticoagulation either receive inpatient therapy or die within 5 years. 5,6 These complications occur even though most atrial fibrillation-related ischemic strokes can be prevented with anticoagulation, 3,4 and rate control often renders patients asymptomatic.…”

Tópicos Emergentes em Insuficiência Cardíaca: Terapias Intervencionistas na Insuficiência Cardíaca

“…A ablação de FA em pacientes com IC tem um benefício maior do que o uso de drogas antiarrítmicas, pela maior taxa de manutenção de ritmo sinusal, melhora de capacidade funcional e qualidade de vida, NYHA, distância no teste de caminhada de 6 minutos, VO2 máximo, 9 redução de biomarcadores (BNP), aumento de fração de ejeção, 9,10 redução de hospitalização por IC, morte ou hospitalização por IC e morte por qualquer causa. [9][10][11] Entretanto, a taxa de sucesso varia de 60 a 80% no primeiro ano em que doença cardíaca estrutural é um fator de risco para recorrência. 12 O isolamento das veias pulmonares pode ser feito por radiofrequência ou crioablação e essas técnicas podem ser combinadas com ablação de outros substratos.…”

The efficacy and safety of amiodarone combined with beta-blockers in the maintenance of sinus rhythm for atrial fibrillation

“…In the patients who have converted to sinus rhythm, only 20% to 30% could remain in sinus rhythm 1 year later. [ 10 , 11 ] Rhythm control in the early stage of AF is helpful to delay the progression and reduce the occurrence of AF-related complications, [ 12 ] which can be regarded as the first choice for the treatment of recent-onset AF patients, paroxysmal AF patients, failed ventricular rate control patients, and the young patients who cannot tolerate AF symptoms. [ 13 , 14 ]…”