open access

Vol 20, No 4 (2013)
Original articles
Published online: 2013-07-26
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Rate versus rhythm control and outcomes in patients with atrial fibrillation and chronic kidney disease: Data from the GUSTO-III Trial

Eric S. Williams, Vivian P. Thompson, Karen E. Chiswell, John H. Alexander, Harvey D. White, E. Magnus Ohman, Sana M. Al-Khatib
DOI: 10.5603/CJ.2013.0104
·
Cardiol J 2013;20(4):439-446.

open access

Vol 20, No 4 (2013)
Original articles
Published online: 2013-07-26

Abstract

Background: Atrial fi brillation (AF) and chronic kidney disease (CKD) have both been
shown to portend worse outcomes after acute myocardial infarction (MI); however, the benefi t
of a rhythm control strategy in patients with CKD post-MI is unclear.

Methods: We prospectively studied 985 patients with new-onset AF post-MI in the
GUSTO-III trial, of whom 413 (42%) had CKD (creatinine clearance < 60 mL/min).
A rhythm control strategy, defi ned as the use of an antiarrhythmic medication and/or
electrical cardioversion, was used in 346 (35%) of patients.

Results: A rhythm control strategy was used in 34% of patients with CKD and 36% of patients
with no CKD. At hospital discharge, sinus rhythm was present in 487 (76%) of patients treated
with a rate control strategy, vs. 276 (80%) in those treated with rhythm control (p = 0.20). CKD
was associated with a lower odds of sinus rhythm at discharge (unadjusted OR 0.56, 95% CI
0.38–0.84, p < 0.001). However, in multivariable analyses, treatment with a rhythm control
strategy was not associated with discharge rhythm (HR 1.068, 95% CI 0.69–1.66, p = 0.77),
30-day mortality (HR 0.78, 95% CI 0.54–1.12, p = 0.18) or mortality from day 30 to 1 year
(HR 1.00, 95% CI 0.59–1.69, p = 0.99). CKD status did not signifi cantly impact the relationship
between rhythm control and outcomes.

Conclusions: Treatment with a rhythm or rate control strategy does not signifi cantly impact
short-term or long-term mortality in patients with post-MI AF, regardless of kidney disease status.
Future studies to investigate the optimal management of AF in CKD patients are needed.

Abstract

Background: Atrial fi brillation (AF) and chronic kidney disease (CKD) have both been
shown to portend worse outcomes after acute myocardial infarction (MI); however, the benefi t
of a rhythm control strategy in patients with CKD post-MI is unclear.

Methods: We prospectively studied 985 patients with new-onset AF post-MI in the
GUSTO-III trial, of whom 413 (42%) had CKD (creatinine clearance < 60 mL/min).
A rhythm control strategy, defi ned as the use of an antiarrhythmic medication and/or
electrical cardioversion, was used in 346 (35%) of patients.

Results: A rhythm control strategy was used in 34% of patients with CKD and 36% of patients
with no CKD. At hospital discharge, sinus rhythm was present in 487 (76%) of patients treated
with a rate control strategy, vs. 276 (80%) in those treated with rhythm control (p = 0.20). CKD
was associated with a lower odds of sinus rhythm at discharge (unadjusted OR 0.56, 95% CI
0.38–0.84, p < 0.001). However, in multivariable analyses, treatment with a rhythm control
strategy was not associated with discharge rhythm (HR 1.068, 95% CI 0.69–1.66, p = 0.77),
30-day mortality (HR 0.78, 95% CI 0.54–1.12, p = 0.18) or mortality from day 30 to 1 year
(HR 1.00, 95% CI 0.59–1.69, p = 0.99). CKD status did not signifi cantly impact the relationship
between rhythm control and outcomes.

Conclusions: Treatment with a rhythm or rate control strategy does not signifi cantly impact
short-term or long-term mortality in patients with post-MI AF, regardless of kidney disease status.
Future studies to investigate the optimal management of AF in CKD patients are needed.
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Keywords

atrial fi brillation, chronic kidney disease, antiarrhythmic medications, myocardial infarction

About this article
Title

Rate versus rhythm control and outcomes in patients with atrial fibrillation and chronic kidney disease: Data from the GUSTO-III Trial

Journal

Cardiology Journal

Issue

Vol 20, No 4 (2013)

Pages

439-446

Published online

2013-07-26

DOI

10.5603/CJ.2013.0104

Bibliographic record

Cardiol J 2013;20(4):439-446.

Keywords

atrial fi brillation
chronic kidney disease
antiarrhythmic medications
myocardial infarction

Authors

Eric S. Williams
Vivian P. Thompson
Karen E. Chiswell
John H. Alexander
Harvey D. White
E. Magnus Ohman
Sana M. Al-Khatib

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