Rate Versus Rhythm Control for Atrial Fibrillation: From Affirm to EAST-AFNET 4 – a Paradigm Shift

Roman, Sherif; Patel, Kevin; Hana, David; Guice, K.C.; Patel, Jay; Stadnick, Christopher; Basta, Amir; Khouzam, Rami N.

doi:10.2217/fca-2021-0034

Cited by 4 publications

(3 citation statements)

References 47 publications

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“…By doing so, it is possible to lower the risk of stroke and other heart-related complications associated with AF, especially for selected patients 1 . Moreover, this focus on early rhythm management has largely resolved the longstanding controversy of whether to prioritize rhythm control or rate control, thus shifting the paradigm of AF treatment from 'better symptoms control' to reducing the incidence of MACCE 23 .…”

Section: Discussionmentioning

confidence: 99%

Optimal Timing for Atrial Fibrillation Patients to Undergo Catheter Ablation: Insights from Long-Term Outcome Studies

Lin,

Rong,

Zhang

et al. 2024

Preprint

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Background Despite catheter ablation being an established treatment for atrial fibrillation (AF), optimal timing for this procedure to improve long-term outcomes remains uncertain. Objective To investigate the impact of diagnosis-to-ablation time (DAT) on AF recurrence and major adverse cardiovascular and cerebrovascular events (MACCE) following catheter ablation. Methods This study retrospectively analyzed prospective observational data from a single center, including 2,097 participants undergoing AF ablation between January 2016 and December 2020. Baseline characteristics, clinical outcomes, and the incidence of MACCE were evaluated. Patients were stratified by DAT: ≤ 1 year, > 1 to ≤ 3 years, and > 3 years. Cox proportional hazards and logistic regression analyses were used to identify predictors of AF recurrence and MACCE Results During the 46.89 ± 16.46 months follow-up, AF recurred in 512 patients (24.6%). Early intervention (DAT ≤ 1 year or ≤ 3 years) corresponded with higher AF-free survival, particularly in patients with persistent AF (HR reference to DAT ≤ 1 year: 1.548 [95%CI: 1.139–2.102]). Patients with DAT > 3 years had higher risks of AF recurrence within two years, but long-term recurrence rates stabilized across DAT groups. Left atrial diameter ≥ 40 mm and female gender were identified as independent predictors of AF recurrence. The overall impact of DAT on MACCE occurrence was not significant, with age and vascular disease being independent predictors. Conclusions Early catheter ablation is preferable for maintaining sinus rhythm, particularly in persistent AF. However, DAT did not influence the incidence of MACCE. These findings endorse the paradigm shift towards early ablation but also emphasize the importance of personalized treatment strategies based on individual patient profiles.

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Section: Discussionmentioning

confidence: 99%

Optimal Timing for Atrial Fibrillation Patients to Undergo Catheter Ablation: Insights from Long-Term Outcome Studies

Lin,

Rong,

Zhang

et al. 2024

Preprint

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“…Over the next two decades, PV isolation became the gold standard of AF ablative treatment and we saw a vivid and rapid improvement in techniques and technologies aiming to a durable and, at the same time, safer and faster PV lesions. Moreover, during this period we testified also a growing enthusiasm toward AF ablation supported by trials (CABANA and its substudies, and EAST-AFNET4) demonstrating that rhythm control—especially when achieved by ablation—improves outcomes over the only rate control and thus refusing the previous dogma according to which there were no differences in outcomes between rate and rhythm control (AFFIRM) [ 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. Clinical evidence is also going towards the demonstration that the best rhythm strategy control is ablative and not pharmacological, above all if performed as soon as possible, in an early stage to avoid the onset of an irreversible and self-feeding atrial cardiomyopathy.…”

Section: Introductionmentioning

confidence: 92%

Ablation of Paroxysmal Atrial Fibrillation: between Present and Future

Robles,

Palamà,

Scarà

et al. 2024

Rev. Cardiovasc. Med.

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Pulmonary vein isolation (PVI) is the established cornerstone for atrial fibrillation (AF) ablation, indeed current guidelines recognize PVI as the gold standard for first-time AF ablation, regardless of if it is paroxysmal or persistent. Since 1998 when Haïssaguerre pioneered AF ablation demonstrating a burden reduction after segmental pulmonary vein (PV) ablation, our approach to PVI was superior in terms of methodology and technology. This review aims to describe how paroxysmal atrial fibrillation ablation has evolved over the last twenty years. We will focus on available techniques, a mechanistic understanding of paroxysmal AF genesis and the possibility of a tailored approach for the treatment of AF, before concluding with a future perspective.

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“…A meta-analysis of randomized controlled trials (RCTs) comparing rate control and rhythm control strategies for AF found no significant differences in mortality or stroke rates between the 2 strategies but showed that the rate control strategy was associated with a lower risk of adverse events [14] . Therefore, rate control is the preferred strategy for most patients with AF, particularly those with comorbidities or who are older [15] .…”

Section: Rate Controlmentioning

confidence: 99%

Risk factors and management strategies for atrial fibrillation

Durrani,

Fatima,

Shaikh

2023

International Journal of Surgery: Global Health

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Atrial fibrillation (AF) is a cardiac arrhythmia characterised by the irregular and frequently fast depolarization of the atrial myocardium resulting from a disturbance of the usual electrical conduction routes within the atria, which causes disorganised and ineffective atrial contractions. The management of AF involves a multidisciplinary approach that includes identifying and treating underlying risk factors, managing symptoms, and preventing complications. The risk factors for AF include age, hypertension, obesity, diabetes mellitus, valvular heart disease, coronary artery disease, congestive heart failure, alcohol consumption, sleep apnea, and family history. The management strategies for AF include rate control, rhythm control, anticoagulation, left atrial appendage closure, lifestyle modifications, surgical ablation, catheter ablation, cardioversion, and education and support. The choice of management strategy should be tailored to the individual patient’s risk profile, comorbidities, and other factors. Further research is needed to improve our understanding of the pathophysiology of AF and to develop more effective management strategies for this condition.

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Rate Versus Rhythm Control for Atrial Fibrillation: From Affirm to EAST-AFNET 4 – a Paradigm Shift

Cited by 4 publications

References 47 publications

Optimal Timing for Atrial Fibrillation Patients to Undergo Catheter Ablation: Insights from Long-Term Outcome Studies

Optimal Timing for Atrial Fibrillation Patients to Undergo Catheter Ablation: Insights from Long-Term Outcome Studies

Ablation of Paroxysmal Atrial Fibrillation: between Present and Future

Risk factors and management strategies for atrial fibrillation

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