Frequency of Symptomatic Atrial Fibrillation in Patients Enrolled in the Atrial Fibrillation Follow‐up Investigation of Rhythm Management (AFFIRM) Study

Epstein, Andrew E.; Vidaillet, Humberto; Greene, H. Leon; Curtis, Anne B.; Ellenbogen, Kenneth A.; Simmons, Todd; Mickel, Mary

doi:10.1046/j.1540-8167.2002.00667.x

Cited by 14 publications

(5 citation statements)

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“…Advantages of restoring SR in cases with AF include a marked relief of symptoms, improved cardiac hemodynamics and a decrease in the number of thromboembolic events. 3,10 The results of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) and Rate Control Versus Electrical Cardioversion (RACE) studies showed that the risk of embolism and the relief of symptoms does not decrease after restoring SR. [16][17][18][19][20][21] In the AFFIRM study, patients who had at least 1 other risk factor for stroke and death were randomly assigned to either the rate or rhythm control group. [16][17][18][19][20][21] In that trial, risk factors were: being aged ≥65 years, having systemic hypertension, diabetes mellitus, congestive heart failure, transient ischemic attack, prior stroke, left atrium ≥50 mm, and left ventricular fractional shortening of <25% or left ventricular ejection fraction of <0.40.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Rate and Rhythm Control in Hypertension Patients With Atrial Fibrillation

Yıldız¹,

Yiğit

Ökçün

et al. 2008

Circ J

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trial fibrillation (AF) is the most frequent reason for hospital admission and is also the most common sustained cardiac arrhythmia, occurring in 0.4% of the adult population. 1,2 Its prevalence is age-related and increases significantly to 1-4% after 60 years of age. [1][2][3] Owing to the age structure of Turkey's population and the increasing morbidity and comorbidity, one must assume that this arrhythmia will reach an even higher prevalence. AF is associated with a significantly higher risk of systemic embolism, congestive heart failure and death. [1][2][3][4] AF and hypertension are 2 prevalent, and often coexisting, conditions in the adult population. 5-7 Their incidence increases with age, and they are responsible for considerable morbidity and mortality. 5,6 The purpose of the present study was to determine whether a strategy that attempts to restore and maintain sinus rhythm (SR) in AF will improve survival and exercise capacity among patients with hypertension. MethodsPatients aged >18 years who had hypertension and persistent AF for >48 h were included in the study. AF was defined as having: an absence of P-waves, course or fine fibrillatory waves, and completely irregular R-R intervals.The diagnosis of essential hypertension was defined as having BP >140/90 mmHg, or current use of antihyperten- Patients suffering from valvular heart diseases, coronary artery disease, heart failure, thyroid disease, renal failure, sick sinus syndrome, pulmonary embolism, acute pericarditis, diabetes mellitus, chronic obstructive lung disease, hypertrophic obstructive cardiomyopathy and atrial thrombus were excluded from the study.The patients were randomly assigned to either the rhythm control group or rate control group. The patients were kept under observation for a minumum follow-up period of 3 years, with regular weekly visits in the 1 st month and then once a month thereafter. The composite endpoints of the study were embolism, death and exercise capacity for both groups.At baseline, resting 12-lead ECG was obtained, and transthoracic echocardiography (TTE), transesophageal echocardiograph (TEE) and exercise tests were performed. At every control visit, a 12-lead ECG was taken. At the end of the 1 st year all patients underwent exercise testing.The TTE and TEE studies were performed with an Acuson 128 XP/5 ultrasound system. M-mode TTE was used to measure the left atrial dimension at end-systole and the LVEF, according to the recommendations of the American Society of Echocardiography. Food consumption was stopped at least 4 h before the TEE was done. Patients received local pharyngeal anesthesia (1% lidocaine spray) as the only premedication, and were given effective anticoagulation either with heparin or warfarin (INR levels 2.0-3.0 or APTT 2 times control, 60-80 s) before the TEE. Patients in whom the TEE did not detect any thrombus were cardioverted to SR. For cardioversion (CV), amiodarone (administered intravenously (iv)) was used (300 mg over 1 h, then 15-20 mg/kg for the remaining 23 h). If CV was not ach...

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Section: Discussionmentioning

confidence: 99%

Comparison of Rate and Rhythm Control in Hypertension Patients With Atrial Fibrillation

Yıldız¹,

Yiğit

Ökçün

et al. 2008

Circ J

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“…Restoration of SR in patients with AF for primary prevention were examined in the Atrial Fibrillation Follow-up Investigation of Rhythm Management 15 and Rate Control Versus Electrical Cardioversion 16 studies. These 2 studies showed that the cardioversion of patients with high risk of stroke provided no benefit in terms of embolism, death, and the relief of symptoms over rate control.…”

Section: Discussionmentioning

confidence: 99%

“…In these 2 groups, most of the strokes occurred in patients in whom the warfarin therapy was stopped or in patients with INR <2.0. 15,16 Therefore, effective anticoagulation was recommended to all patients with risk factors for stroke.…”

Section: Discussionmentioning

confidence: 99%

Do Restoring and Maintaining Sinus Rhythm Have a Beneficial Effect on Secondary Prevention of Stroke in Patients With Atrial Fibrillation? A Pilot Study

et al. 2019

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We aimed to determine whether attempts to restore and maintain sinus rhythm will reduce recurrent stroke in patients with atrial fibrillation (AF). Patients (n = 245) between March 1998 and May 2002 with AF who had an ischemic stroke including transient ischemic attack 1 to 12 months before transesophageal echocardiographic examination and had been followed for 3 years were retrospectively reviewed. Cardioversion was attempted in 130 patients; 117 (90%) patients were successfully cardioverted (rhythm control group). The 13 patients who could not be cardioverted and 115 patients who did not undergo cardioversion were assigned to the rate control group. Age, gender, ischemic heart disease, hypertension, diabetes mellitus, congestive heart failure, mitral valve disease, and left atrial diameter were similar in both groups. The rhythm control group included 56 patients (48.7%) who were still in sinus rhythm after 3 years. During follow-up, there were 2 embolic events (3.4%) and 2 deaths (3.4%) in the rhythm control group, whereas 18 embolic events (14.6%) and 18 deaths (14.6%) occurred in the rate control group ( P = .049 and P = .049, respectively). Restoration and maintenance of sinus rhythm seems to have a beneficial effect on secondary prevention of stroke in patients with AF.

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“…We separated the patients into the frequent and the infrequent PAF groups according to the frequency of PAF episodes experienced within the last 6 months. We selected “the last 6 months” in proportion to the AFFIRM study 8 . Indeed, the frequency of PAF was not always constant in each patient.…”

Section: Discussionmentioning

confidence: 99%

“…The subjects were divided into two groups according to the frequency of PAF episodes experienced within the last 6 months before electrophysiological study: patients with at least one episode of PAF per month (frequent group, n = 57) and patients with less than one episode of PAF per month (infrequent group, n = 51). This classification was based on that from the AFFIRM study 8 . The duration of PAF history was defined as the time interval from the date of the first episode of PAF to the date of the electrophysiological study.…”

Section: Methodsmentioning

confidence: 99%

Relation Between History of Paroxysmal Atrial Fibrillation and Electrophysiological Abnormalities of Atrial Muscle

Nakao

Seto

Shibata

et al. 2004

Pacing Clinical Electrophis

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Although electrophysiological abnormalities of atrial muscle have been evaluated in patients with paroxysmal atrial fibrillation (PAF), no prior study has determined the contribution of the patient's history of PAF to electrophysiological abnormalities. The study population consisted of 108 patients (71 men; mean age, 57 +/- 14 years) with symptomatic and idiopathic PAF who underwent electrophysiological study. Before electrophysiological study, histories of frequency, number of PAF episodes per month, and duration, a time interval from the first episode of PAF to electrophysiological study, were examined. At electrophysiological study, endocardial electrograms from 12 right atrial sites were recorded during sinus rhythm, and the right atrial effective refractory period was determined. Longest duration of atrial electrograms, maximal number of fragmented deflections, and number of abnormal atrial electrograms recorded at the right atrial sites were significantly greater in the frequent group (> 1 PAF episode per month, n = 57) than in the infrequent group (< 1 PAF episode per month, n = 51) (98 +/- 18 ms vs 88 +/- 16 ms, P < 0.005; 8.7 +/- 2.6 vs 7.5 +/- 2.6, P < 0.05; and 2.2 +/- 2.2 vs 1.4 +/- 1.6, P < 0.05, respectively). Indices of atrial vulnerability were also greater in the frequent group. Duration of PAF history was significantly correlated with longest duration r = 0.52, P < 0.0001), maximal number of fragmented deflections r = 0.51, P < 0.0001), and number of abnormal atrial electrograms r = 0.58, P < 0.0001). More frequent episodes and longer history of PAF significantly increased the electrophysiological abnormalities of the atrial muscle, suggesting that PAF results in gradual electrical remodeling of the atrial muscle.

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Frequency of Symptomatic Atrial Fibrillation in Patients Enrolled in the Atrial Fibrillation Follow‐up Investigation of Rhythm Management (AFFIRM) Study

Cited by 14 publications

References 1 publication

Comparison of Rate and Rhythm Control in Hypertension Patients With Atrial Fibrillation

Comparison of Rate and Rhythm Control in Hypertension Patients With Atrial Fibrillation

Do Restoring and Maintaining Sinus Rhythm Have a Beneficial Effect on Secondary Prevention of Stroke in Patients With Atrial Fibrillation? A Pilot Study

Relation Between History of Paroxysmal Atrial Fibrillation and Electrophysiological Abnormalities of Atrial Muscle

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