Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation: results of the RACE 3 trial

Rienstra, Michiel; Hobbelt, Anne H; Alings, Marco; Tijssen, Jan G.P.; Smit, Marcelle D.; Brügemann, Johan; Geelhoed, Bastiaan; Tieleman, Robert G; Hillege, Hans L.; Tukkie, Raymond; Veldhuisen, Dirk J. van; Crijns, Harry J.G.M.; Gelder, Isabelle C. Van; Investigators, Race

doi:10.1093/eurheartj/ehx739

Cited by 244 publications

(204 citation statements)

References 31 publications

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“…These patients may have easier access to medical care, and therefore more likely to undergo more intensive risk factor management. Beneficial effects on AF have been reported with a better control of blood pressure, glucose level, BMI, and with greater physical activity 33‐35 . According to our recently published study, better risk factor management was associated with a lower risk of AT recurrence postablation 36 …”

Section: Discussionmentioning

confidence: 87%

Effectiveness and safety of atrial fibrillation ablation in females

Sang

et al. 2020

Pacing Clinical Electrophis

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Background Existing data on the effectiveness and safety of atrial fibrillation (AF) ablation in females are limited to studies of small sample size, lacking longer term follow‐up or adjustment for potential confounders. Methods A total of 6421 patients (2072 females) undergoing a first AF ablation procedure after enrollment in the Chinese Atrial Fibrillation Registry (China‐AF) study between August 2011 and December 2017 were analyzed. We evaluated the effectiveness (recurrence of documented [symptomatic or not] atrial tachyarrhythmia (AT)) and the safety (incidence of procedure‐related complications) of AF ablation in female patients compared to male patients. Sensitivity analyses based on routine data were also utilized to avoid potential sex differences in reporting of AF symptoms. Results Females were about 5 years older than males at the time of ablation (mean age 63.4 ± 9.5 vs 58.3 ± 10.8, P < .0001). A higher proportion of female patients had paroxysmal AF (74.3% vs 56.7%, P < .0001), hypertension (69.7% vs 61.3%, P < .0001), and hyperlipidemia (57.2% vs 52.9%, P = .001). Female sex was found to be an independent risk factor of AT recurrence in multivariate analyses (HR = 1.26, 95% CI 1.15‐1.38, P < .0001). These findings were confirmed in sensitivity analyses using only Holter data. Female sex was also associated with a higher risk of periprocedural complications after adjustment for baseline variables (OR = 1.41, 95% CI 1.03‐1.94, P = .03). Conclusions Female sex is an independent risk factor of AT recurrence and periprocedural complications after AF ablation.

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Section: Discussionmentioning

confidence: 87%

Effectiveness and safety of atrial fibrillation ablation in females

Sang

et al. 2020

Pacing Clinical Electrophis

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“…In the RACE 3 trial, this approach led to a slight reduction in BMI and weight at 1 year as well as improved sinus rhythm maintenance. 26 These figures also demonstrate that a substantial improvement requires long-term patient involvement and persistent adherence to treatment.…”

Section: Obesitymentioning

confidence: 91%

Risk Factor Management in Atrial Fibrillation

Brandes¹,

Smit²,

Nguyen³

et al. 2018

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common clinical arrhythmia and is associated with increased morbidity and mortality. There is growing evidence that numerous cardiovascular diseases and risk factors are associated with incident AF and that lone AF is rare. Beyond oral anticoagulant therapy, rate and rhythm control, therapy targeting risk factors and underlying conditions is an emerging AF management strategy that warrants better implementation in clinical practice. This review describes current evidence regarding the association between known modifiable risk factors and underlying conditions and the development and progression of AF. It discusses evidence for the early management of underlying conditions to improve AF outcomes. It also provides perspective on the implementation of tailored AF management in daily clinical practice.

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“…In line with the above findings, the RACE-3 study (Rienstra et al, 2018), whose results were presented at the congress of the European Society of Cardiology in August 2017, included patients with mild-to-moderate heart failure for less than 1 year and persistent AF with less than 5 years of history and episodes lasting less than 6 months, who were selected for electrical cardioversion. Patients were randomized to receive intensive treatment against cardiovascular risk factors and upstream therapy or perform conventional management.…”

Section: B Remodeling and Upstream Therapies In Atrial Fibrillationmentioning

confidence: 86%

Mechanisms and Drug Development in Atrial Fibrillation

2018

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Atrial fibrillation is a highly prevalent cardiac arrhythmia and the most important cause of embolic stroke. Although genetic studies have identified an increasing assembly of AF-related genes, the impact of these genetic discoveries is yet to be realized. In addition, despite more than a century of research and speculation, the molecular and cellular mechanisms underlying AF have not been established, and therapy for AF, particularly persistent AF, remains suboptimal. Current antiarrhythmic drugs are associated with a significant rate of adverse events, particularly proarrhythmia, which may explain why many highly symptomatic AF patients are not receiving any rhythm control therapy. This review focuses on recent advances in AF research, including its epidemiology, genetics, and pathophysiological mechanisms. We then discuss the status of antiarrhythmic drug therapy for AF today, reviewing molecular mechanisms, and the possible clinical use of some of the new atrial-selective antifibrillatory agents, as well as drugs that target atrial remodeling, inflammation and fibrosis, which are being tested as upstream therapies to prevent AF perpetuation. Altogether, the objective is to highlight the magnitude and endemic dimension of AF, which requires a significant effort to develop new and effective antiarrhythmic drugs, but also improve AF prevention and treatment of risk factors that are associated with AF complications.

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Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation: results of the RACE 3 trial

Abstract: Clinicaltrials.gov NCT00877643.

Cited by 244 publications

References 31 publications

Effectiveness and safety of atrial fibrillation ablation in females

Effectiveness and safety of atrial fibrillation ablation in females

Risk Factor Management in Atrial Fibrillation

Mechanisms and Drug Development in Atrial Fibrillation

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