Comparison of recurrence rates after direct-current cardioversion for new-onset atrial fibrillation in patients receiving versus those not receiving rhythm-control drug therapy

Li, Huagui; Riedel, Roger; Oldemeyer, J. Bradley; Rovang, Karen; Hee, Tom

doi:10.1016/j.amjcard.2003.09.010

Cited by 11 publications

(8 citation statements)

References 6 publications

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“…However, despite the very high initial success rate associated with CV, early relapse is common, with as many as two-thirds of AF recurrences occurring within the first month (1)(2)(3). Similar observations have been made with atrial flutter (1).…”

mentioning

confidence: 61%

High Sensitivity C-Reactive Protein

Malouf

Kanagala

Atawi

et al. 2005

Journal of the American College of Cardiology

115

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mentioning

confidence: 61%

High Sensitivity C-Reactive Protein

Malouf

Kanagala

Atawi

et al. 2005

Journal of the American College of Cardiology

115

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“…The treatment of AF is complex [14] and challenging to manage in practice [15]. Furthermore, AF is characterized by frequent recurrences [16] with rates ranging from 22 to 83%, depending on therapy, time, and study [17][18][19][20][21][22]. In order to achieve optimal therapeutic management of AF and minimize the risk of complications, active patient participation is essential [23], as well as emphasizing the importance of patients' selfmanagement [24].…”

Section: Introductionmentioning

confidence: 99%

A self-management support intervention for patients with atrial fibrillation: a randomized controlled pilot trial

Jobst¹,

Leppla²,

Köberich³

2020

Pilot Feasibility Stud

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Background: Atrial fibrillation (AF) is the most common arrhythmia worldwide. Despite effective treatment, it is characterized by frequent recurrences. Optimal therapeutic management of AF requires active participation and self-management from patients. Two major components of self-management are self-monitoring and sign-andsymptom management. Pulse self-palpation (PSP) is a method of self-monitoring; however, not all AF patients are capable of successfully performing PSP. Due to a lack of interventions on this topic, a nurse-led intervention for patients with AF (PSPAF intervention) was developed to foster self-monitoring and to enhance self-management through PSP. The purpose of this pilot study was to test the acceptability, feasibility, and potential effects of this intervention on the capability of patients' PSP and sign-and-symptom management. Moreover, we aimed at gathering data on the feasibility of applied research methods to aid in the design of future studies. Methods: The pilot trial involved 20 adult patients with AF, randomized to an intervention or usual care group. At baseline and during a home visit 3-5 weeks later, we collected data using questionnaires, checklists, field notes, a mobile ECG device, and a diary. Acceptability and feasibility measures were validated through predefined cutoff points. Effect size estimates were expressed as relative risks (RR) and the number needed to treat (NNT). Results: The PSPAF intervention seemed feasible, but only partly acceptable. There were limitations in terms of potential effectiveness, suitability, addressing participants' willingness to implement its content in daily life, and adherence. Estimations of effect sizes suggest a large effect of the intervention on patients' PSP capability (RR = 6.0; 95% CI = [0.83, 43.3]; NNT = 2.4), but almost no effect on sign-and-symptom management (RR = 1.5; 95% CI = [0.7, 3.1]; NNT = 4.0). The feasibility of applied research methods showed minor limitations on recruitment and participant burden. Conclusions: Despite some limitations, the intervention seemed to be applicable and promising. Taking into account the suggestions and amendments we have made, we recommend conducting a full-scale trial to examine the efficacy of the PSPAF intervention.

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“…A number of antiarrhythmic drug have been shown to be of benefit [9-13]. What remains unclear is whether these drugs also promote maintenance of sinus rhythm in the early post-procedural period, or longer term [10, 14, 15]. More recently there has been evidence to suggest that inhibition of the renin-angiotensin-aldosterone system (RAAS) might not only improve the initial success rate of the procedure, but also subsequent maintenance of sinus rhythm [16, 17].…”

Section: Introductionmentioning

confidence: 99%

Adjunctive Pharmacotherapy for Elective Direct Current Cardioversion in Patients With Atrial Fibrillation

Hirt

Gobin

2012

Cardiol Res

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BackgroundDirect current cardioversion (DCCV) can restore sinus rhythm in patients with atrial fibrillation (AF), but the long term efficacy is poor. Pharmacological therapies may improve the initial success of the procedure, but whether long term maintenance of sinus rhythm can be improved is unclear. The aim of this study was to evaluate which pharmacotherapies, including antiarrhythmic and renin-angiotensin-aldosterone system (RAAS) inhibiting drugs, most successfully promotes sinus rhythm after elective DCCV in unselected patients with atrial fibrillation.MethodsA retrospective cohort was to study of AF patients attending or DCCV between Jan 2010 and Feb 2012. The data were analysed using multivariate logistical regression models. Initial success of DCCV was the dependent variable in the first analysis. Maintenance of sinus rhythm at follow up was the dependent variable in the second analysis.ResultsOne hundred and thirty patients were included in the first analysis, and 71 patients were included in the second analysis. The only association observed was a positive association between flecainide and an increased odds of maintaining sinus rhythm at follow up (OR 2.14, SE ± 0.93, P = 0.02) .Other antiarrhythmic drugs and RAAS inhibiting drugs had no association with an increased odds of successful DCCV or maintenance of sinus rhythm thereafter.ConclusionsThis is the first study to demonstrate an association between flecainide and a increased odds of maintaining sinus rhythm after DCCV in the long term. This warrants further research, and should be taken into account when choosing adjunctive antiarrhythmic therapy for elective DCCV for AF.

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Comparison of recurrence rates after direct-current cardioversion for new-onset atrial fibrillation in patients receiving versus those not receiving rhythm-control drug therapy

Cited by 11 publications

References 6 publications

High Sensitivity C-Reactive Protein

High Sensitivity C-Reactive Protein

A self-management support intervention for patients with atrial fibrillation: a randomized controlled pilot trial

Adjunctive Pharmacotherapy for Elective Direct Current Cardioversion in Patients With Atrial Fibrillation

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