Rate vs Rhythm Control in Patients With Atrial Fibrillation

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

doi:10.1001/archinte.165.3.258

Cited by 215 publications

(56 citation statements)

References 18 publications

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“…Gdy leki antyarytmiczne zawiodą, często skuteczna jest ablacja przezcewnikowa lub leczenie skojarzone [226,[585][586][587]. Choć wielu klinicystów sądzi, że utrzymywanie rytmu zatokowego może poprawiać wyniki leczenia u pacjentów z AF [588], to we wszystkich próbach klinicznych, w których porównano kontrolę rytmu serca i kontrolę częstości rytmu komór z samą kontrolą częstości rytmu komór (w połą-czeniu z odpowiednim leczeniem przeciwzakrzepowym), uzyskano neutralne wyniki leczenia [41,578,579,582,[589][590][591][592][593]. Kwestia, czy współczesne postępowanie w celu kontroli rytmu serca, obejmujące ablację przezcewnikową, leczenie skojarzone oraz wczesne leczenie, prowadzi do Podczas stosowania strategii kontroli częstości rytmu komór jako początkowy cel leczenia należy rozważyć częstość rytmu komór w spoczynku < 110 uderzeń na minutę (tj.…”

Section: Leczenie W Celu Kontroli Rytmu Serca U Pacjentów Z Migotanieunclassified

“…Farmakoterapia antyarytmiczna powoduje w przybliżeniu podwojenie częstości utrzymywania rytmu zatokowego w porównaniu z brakiem leczenia [580]. Nie ma zauważalnego wpływu na umieralność ani występowanie powikłań sercowo-naczyniowych, ale leczenie w celu kontroli rytmu serca może nieco zwiększać ryzyko hospitalizacji (często z powodu AF) [41,578,579,582,[589][590][591][592][593]. W celu zmniejszenia ryzyka działań niepożądanych [201,580] właściwy wydaje się krótszy okres farmakoterapii antyarytmicznej.…”

Section: Długoterminowe Leczenieunclassified

See 1 more Smart Citation

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,402

4,206

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Section: Leczenie W Celu Kontroli Rytmu Serca U Pacjentów Z Migotanieunclassified

Section: Długoterminowe Leczenieunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,402

4,206

View full text Add to dashboard Cite

“…Several studies (including the landmark AFFIRM trial) 33 have shown that there is no difference in survival or thromboembolism in patients with AF who are treated with rhythm control as opposed to rate control. [33][34][35][36][37][38] Is there a difference in thromboembolic risk between electrical and pharmacological cardioversion?…”

Section: Is Acute Rhythm Control Worth the Risk?mentioning

confidence: 99%

Cardioverting acute atrial fibrillation and the risk of thromboembolism: not all patients are created equal

Rankin

2017

Clinical Medicine

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Current guidelines support the well-established clinical practice that patients who present with atrial fi brillation (AF) of less than 48 hours duration should be considered for cardioversion, even in the absence of pre-existing anticoagulation. However, with increasing evidence that short runs of AF confer signifi cant risk of stroke, on what evidence is this 48-hour rule based and is it time to adopt a new approach? We review existing evidence and suggest a novel approach to risk stratifi cation in this setting. Overall, the risk of thromboembolism associated with acute cardioversion of patients with AF that is estimated to be of <48 hours duration is low. However, this risk varies widely depending on patient characteristics. From existing evidence, we show that using the CHA 2 DS 2 -VASc score may allow better selection of appropriate patients in order to prevent exposing specifi c patient groups to an unacceptably high risk of a potentially devastating complication. KEYWORDS : Anticoagulants , atrial fi brillation , cardioversion , electrical cardioversion , stroke , thromboembolism IntroductionInternational guidelines support the well-established clinical practice that patients who present with non-valvular atrial fibrillation (AF) of less than 48 hours duration should be considered for cardioversion, even in the absence of pre-existing anticoagulation.1,2 The risk with more prolonged periods of AF is that restoration of sinus rhythm may precipitate embolism of intra-atrial thrombus causing stroke. However, with increasing evidence that even short runs of AF confer significant risk of stroke, [3][4][5][6] this review examines the evidence supporting the '48-hour rule' and suggests a novel approach to risk stratification in this setting. Search strategy and selection criteriaData for this review were identified by searches of PubMed using combinations of the terms 'atrial fibrillation', 'cardioversion' and 'thromboembolism'. References sourced ABSTRACTCardioverting acute atrial fi brillation and the risk of thromboembolism: not all patients are created equal from relevant articles were also included. Additional references were identified from review of current international guidelines on the management of atrial fibrillation.

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“…15 In the AF-CHF (Atrial Fibrillation and Congestive Heart Failure) study, 16 >1300 patients with a left ventricular ejection fraction (LVEF) ≤35%, NYHA class II-IV, and a paroxysmal or persistent AF were randomized to rhythm control (82% with amiodarone) or rate control (88% with beta-blockers). At a mean follow-up of 37 months, there was no significant difference in the primary outcome of death from cardiovascular causes between the rhythm and rate control groups (27% vs. 25%, p = 0.59).…”

Section: Rhythm Control or Rate Control For Atrial Fibrillation?mentioning

confidence: 99%

Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy: Therapeutic Options

Petrač¹

2017

Cardiologia Croatica

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Fibrilacija atrija u bolesnika s resinkronizacijskom terapijom srca: terapijske mogućnosti Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy: Therapeutic Options SAŽETAK: Fibrilacija atrija (FA) često je prisutna u bolesnika s resinkronizacijskom terapijom srca (CRT) i može imati znatan negativan utjecaj na prognozu i odgovor na CRT. Liječenje FA-a u bolesnika s CRT-om uključuje optimalnu medikamentu terapiju za zatajivanje srca, antikoagulantnu terapiju i terapiju za kontrolu frekvencije ili kontrolu ritma sa specifičnim ciljem da se osigura visoki postotak (≥98 %) biventrikularne (BiV) stimulacije. U bolesnika sa zatajivanjem srca i FA-om, kontrola ritma antiaritmičnim lijekovima nije uspjela pokazati nikakvu dobit u preživljenju u usporedbi s lijekovima za kontrolu frekvencije. U tom kontekstu kontrola frekvencije lijekovima preferira se kao prvi izbor liječenja u bolesnika s CRT-om i perzistentnom ili trajnom FA. Međutim, opservacijske prospektivne studije i metaanalize pokazuju da je ablacija AV spoja bolja od lijekova za kontrolu frekvencije u postizanju visokog postotka BiV stimulacije i smanjenju smrtnosti. Zbog toga ablacija AV spoja može biti prvi izbor liječenja u bolesnika s CRT-om i trajnom FA. Amiodaron i dofetilid jedini su antiaritmici pogodni za kontrolu ritma u bolesnika s CRT-om, ali uz umjerenu učinkovitost i znatne nuspojave. Kateterska ablacija FA-a drugi je mogući izbor za kontrolu ritma u bolesnika sa CRT-om, jer poboljšava odgovor na CRT pospješujući atrioventrikularnu i interventrikularnu sinkroniju. Prema rezultatima randomiziranih kontroliranih studija u bolesnika sa zatajivanjem srca, ablacija FA može se uzeti u obzir u bolesnika s CRT-om i paroksizmalnom FA, koji ne reagiraju na antiaritmične lijekove, kao i u odabranih bolesnika s perzistentnom FA prije nego što se prihvati terapija za kontrolu frekvencije. SUMMARY:Atrial fibrillation (AF) is often present in patients with cardiac resynchronization therapy (CRT), and may have a significant negative impact on the prognosis and CRT response. Management of AF in CRT patients includes the optimal pharmacological heart failure therapy, anticoagulation therapy, and rate or rhythm control therapy with specific goal to ensure a high percentage (≥98%) of biventricular (BiV) pacing. In heart failure patients with AF, a rhythm control with antiarrhythmic drugs has failed to show any survival benefit compared with a rate control drugs. In this context, a rate control with drugs is preferred as first-line therapy in CRT patients with persistent or permanent AF. However, the observational prospective studies and meta-analyses indicate that AV junction ablation is superior to rate control drugs in achieving adequate BiV pacing and reducing mortality. Therefore, an ablation of AV junction should be considered as the first therapeutic choice in CRT patients with permanent AF. Amiodarone and dofetilide are the lone antiarrhythmic drugs suitable for the rhythm control in CRT patients, but with a moderate efficacy and significant ...

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Rate vs Rhythm Control in Patients With Atrial Fibrillation

Cited by 215 publications

References 18 publications

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Cardioverting acute atrial fibrillation and the risk of thromboembolism: not all patients are created equal

Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy: Therapeutic Options

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