open access

Vol 12, No 6 (2017)
Review Papers
Published online: 2017-12-29
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Rhythm control strategy in patients with non-valvular atrial fibrillation — current knowledge, controversy, ongoing research

Paweł Wałek, Janusz Sielski, Iwona Gorczyca, Katarzyna Starzyk, Radosław Bartkowiak, Beata Wożakowska-Kapłon
DOI: 10.5603/FC.2017.0108
·
Folia Cardiologica 2017;12(6):570-579.

open access

Vol 12, No 6 (2017)
Review Papers
Published online: 2017-12-29

Abstract

The main therapeutic problem in patients with atrial fibrillation (AF), besides determining indications for anticoagulant therapy, is the choice of rhythm control strategy vs rate control strategy. The 2016 guidelines recommend choosing rhythm control strategy “only” in order to reduce the symptoms resulting from arrhythmia. Previous studies comparing these treatment strategies in patients with AF did not reveal the advantage of one strategy over the other. In multicenter studies, such as AFFIRM, RACE, STAFF, PIAF, HOT CAFE, there were no differences between both strategies in terms of mortality and cardiovascular morbidity, although many post-hoc analyzes showed evidence of superiority of rhythm control strategies, taking into account so called soft endpoints, such as improving physical performance or humoral profile. Although current guidelines recommend a paradigm of maintaining sinus rhythm “only” to improve patients’ symptoms, observational studies show that patients with restored and maintained sinus rhythm are characterized by a better prognosis. The article presents the current state of knowledge regarding the choice of treatment strategy in patients with non-valvular AF.

Abstract

The main therapeutic problem in patients with atrial fibrillation (AF), besides determining indications for anticoagulant therapy, is the choice of rhythm control strategy vs rate control strategy. The 2016 guidelines recommend choosing rhythm control strategy “only” in order to reduce the symptoms resulting from arrhythmia. Previous studies comparing these treatment strategies in patients with AF did not reveal the advantage of one strategy over the other. In multicenter studies, such as AFFIRM, RACE, STAFF, PIAF, HOT CAFE, there were no differences between both strategies in terms of mortality and cardiovascular morbidity, although many post-hoc analyzes showed evidence of superiority of rhythm control strategies, taking into account so called soft endpoints, such as improving physical performance or humoral profile. Although current guidelines recommend a paradigm of maintaining sinus rhythm “only” to improve patients’ symptoms, observational studies show that patients with restored and maintained sinus rhythm are characterized by a better prognosis. The article presents the current state of knowledge regarding the choice of treatment strategy in patients with non-valvular AF.
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Keywords

atrial fibrillation, cardioversion, antiarrhythmic agents, oral anticoagulants

About this article
Title

Rhythm control strategy in patients with non-valvular atrial fibrillation — current knowledge, controversy, ongoing research

Journal

Folia Cardiologica

Issue

Vol 12, No 6 (2017)

Pages

570-579

Published online

2017-12-29

DOI

10.5603/FC.2017.0108

Bibliographic record

Folia Cardiologica 2017;12(6):570-579.

Keywords

atrial fibrillation
cardioversion
antiarrhythmic agents
oral anticoagulants

Authors

Paweł Wałek
Janusz Sielski
Iwona Gorczyca
Katarzyna Starzyk
Radosław Bartkowiak
Beata Wożakowska-Kapłon

References (48)
  1. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38): 2893–2962.
  2. Wozakowska-Kaplon B, Opolski G. Atrial natriuretic peptide level after cardioversion of chronic atrial fibrillation. Int J Cardiol. 2002; 83(2): 159–165.
  3. Wozakowska-Kapłon B, Opolski G. Concomitant recovery of atrial mechanical and endocrine function after cardioversion in patients with persistent atrial fibrillation. J Am Coll Cardiol. 2003; 41(10): 1716–1720.
  4. Wozakowska-Kapłon B, Opolski G, Janion M. trial natriuretic peptide before and after cardioversion of persistent atrial fibrillation. Kardiol Pol. 2003; 58(4): 255–263.
  5. Wozakowska-Kapłon B, Opolski G. Improvement in exercise performance after successful cardioversion in patients with persistent atrial fibrillation and symptoms of heart failure. Kardiol Pol. 2003; 59(9): 213–223.
  6. Suman-Horduna I, Roy D, Frasure-Smith N, et al. AF-CHF Trial Investigators. Quality of life and functional capacity in patients with atrial fibrillation and congestive heart failure. J Am Coll Cardiol. 2013; 61(4): 455–460.
  7. Keating RJ, Gersh BJ, Hodge DO, et al. Effect of atrial fibrillation pattern on survival in a community-based cohort. Am J Cardiol. 2005; 96(10): 1420–1424.
  8. Lubitz SA, Moser C, Sullivan L, et al. Atrial fibrillation patterns and risks of subsequent stroke, heart failure, or death in the community. J Am Heart Assoc. 2013; 2(5): e000126.
  9. Ionescu-Ittu R, Abrahamowicz M, Jackevicius CA, et al. Comparative effectiveness of rhythm control vs rate control drug treatment effect on mortality in patients with atrial fibrillation. Arch Intern Med. 2012; 172(13): 997–1004.
  10. Corley SD, Epstein AE, DiMarco JP, et al. AFFIRM Investigators. Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation. 2004; 109(12): 1509–1513.
  11. Saliba W, Schliamser JE, Lavi I, et al. Catheter ablation of atrial fibrillation is associated with reduced risk of stroke and mortality: A propensity score-matched analysis. Heart Rhythm. 2017; 14(5): 635–642.
  12. Wyse DG, Waldo AL, DiMarco JP, et al. Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002; 347(23): 1825–1833.
  13. Lafuente-Lafuente C, Valembois L, Bergmann JF, et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev. 2015(3): CD005049.
  14. Hohnloser SH, Crijns HJ, van Eickels M, et al. ATHENA Investigators. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med. 2009; 360(7): 668–678.
  15. Hunter RJ, McCready J, Diab I, et al. Maintenance of sinus rhythm with an ablation strategy in patients with atrial fibrillation is associated with a lower risk of stroke and death. Heart. 2012; 98(1): 48–53.
  16. Lin YJ, Chao TF, Tsao HM, et al. Successful catheter ablation reduces the risk of cardiovascular events in atrial fibrillation patients with CHA2DS2-VASc risk score of 1 and higher. Europace. 2013; 15(5): 676–684.
  17. Bunch TJ, May HT, Bair TL, et al. Atrial fibrillation ablation patients have long-term stroke rates similar to patients without atrial fibrillation regardless of CHADS2 score. Heart Rhythm. 2013; 10(9): 1272–1277.
  18. ClinicalTrials.gov. Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial (CABANA). https: //clinicaltrials.gov/ct2/show/NCT00911508 (15.11.2017).
  19. ClinicalTrials.gov Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST). https://clinicaltrials.gov/ct2/show/NCT01288352 (15.11.2017).
  20. Ciszewski J, Maciag A, Kowalik I, et al. Comparison of the rhythm control treatment strategy versus the rate control strategy in patients with permanent or long-standing persistent atrial fibrillation and heart failure treated with cardiac resynchronization therapy - a pilot study of Cardiac Resynchronization in Atrial Fibrillation Trial (Pilot-CRAfT): study protocol for a randomized controlled trial. Trials. 2014; 15: 386.
  21. Al-Khatib SM, Arshad A, Balk EM, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines, ACC/AHA Task Force Members, ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014; 130(23): e199–e267.
  22. Farkowski MM, Maciąg A, Żurawska M, et al. Comparative effectiveness and safety of antazoline‑based and propafenone‑based strategies for pharmacological cardioversion of short‑duration atrial fibrillation in the emergency department. Pol Arch Med Wewn. 2016; 126(6): 381–387.
  23. Reiffel JA. Cardioversion for atrial fibrillation: treatment options and advances. Pacing Clin Electrophysiol. 2009; 32(8): 1073–1084.
  24. Kosior DA, Opolski G, Tadeusiak W, et al. Serum troponin I and myoglobin after monophasic versus biphasic transthoracic shocks for cardioversion of persistent atrial fibrillation. Pacing Clin Electrophysiol. 2005; 28 Suppl 1: S128–S132.
  25. Wozakowska-Kaplon B, Janion M, Sielski J, et al. Efficacy of biphasic shock for transthoracic cardioversion of persistent atrial fibrillation: can we predict energy requirements? Pacing Clin Electrophysiol. 2004; 27(6 Pt 1): 764–768.
  26. Kirchhof P, Eckardt L, Loh P, et al. Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial. Lancet. 2002; 360(9342): 1275–1279.
  27. Müssigbrodt A, John S, Kosiuk J, et al. Vernakalant-facilitated electrical cardioversion: comparison of intravenous vernakalant and amiodarone for drug-enhanced electrical cardioversion of atrial fibrillation after failed electrical cardioversion. Europace. 2016; 18(1): 51–56.
  28. Acute Cardioversion Versus Wait And See-approach for Symptomatic Atrial Fibrillation in the Emergency Department (ACWAS). https://clinicaltrials.gov/ct2/show/NCT02248753 (15.11.2017).
  29. Kirchhof P, Andresen D, Bosch R, et al. Short-term versus long-term antiarrhythmic drug treatment after cardioversion of atrial fibrillation (Flec-SL): a prospective, randomised, open-label, blinded endpoint assessment trial. Lancet. 2012; 380(9838): 238–246.
  30. Wilber DJ, Pappone C, Neuzil P, et al. ThermoCool AF Trial Investigators. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circ Arrhythm Electrophysiol. 2009; 2(4): 349–361.
  31. Ganesan AN, Shipp NJ, Brooks AG, et al. Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Am Heart Assoc. 2013; 2(2): e004549.
  32. Dagres N, Hindricks G, Kottkamp H, et al. Complications of atrial fibrillation ablation in a high-volume center in 1,000 procedures: still cause for concern? J Cardiovasc Electrophysiol. 2009; 20(9): 1014–1019.
  33. Verma A, Jiang Cy, Betts TR, et al. STAR AF II Investigators. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015; 372(19): 1812–1822.
  34. Ravens U, Odening KE. Atrial fibrillation: Therapeutic potential of atrial K+ channel blockers. Pharmacol Ther. 2017; 176: 13–21.
  35. Eisenberger M, Bulava A, Kautzner J, et al. Sequential Hybrid CryoMaze Ablation versus Surgical CryoMaze Alone for the Treatment of Atrial Fibrillation (SurHyb): study protocol for a randomized controlled trial. Trials. 2016; 17(1): 518.
  36. LAA Ligation Adjunctive to PVI for Persistent or Longstanding Persistent Atrial Fibrillation (aMAZE). https://clinicaltrials.gov/ct2/show/NCT02513797 ((15.11.2017)).
  37. Kosiuk J, Milani R, Ueberham L, et al. Effect of remote ischemic preconditioning on electrophysiological and biomolecular parameters in nonvalvular paroxysmal atrial fibrillation (RIPPAF study): Rationale and study design of a randomized, controlled clinical trial. Clin Cardiol. 2016; 39(11): 631–635.
  38. Cappato R, Ezekowitz MD, Klein AL, et al. X-VeRT Investigators. Rivaroxaban vs. vitamin K antagonists for cardioversion in atrial fibrillation. Eur Heart J. 2014; 35(47): 3346–3355.
  39. Goette A, Merino JL, Ezekowitz MD, et al. ENSURE-AF investigators. Edoxaban versus enoxaparin-warfarin in patients undergoing cardioversion of atrial fibrillation (ENSURE-AF): a randomised, open-label, phase 3b trial. Lancet. 2016; 388(10055): 1995–2003.
  40. Ezekowitz MD, Pollack CV, Sanders P, et al. Apixaban compared with parenteral heparin and/or vitamin K antagonist in patients with nonvalvular atrial fibrillation undergoing cardioversion: Rationale and design of the EMANATE trial. Am Heart J. 2016; 179: 59–68.
  41. Prevention of Silent Cerebral Thromboembolism by Oral Anticoagulation With Dabigatran After Pulmonary Vein Isolation for Atrial Fibrillation (ODIn-AF). https://clinicaltrials.gov/show/NCT02067182 ((15.11.2017)).
  42. Cappato R, Marchlinski FE, Hohnloser SH, et al. VENTURE-AF Investigators. Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J. 2015; 36(28): 1805–1811.
  43. Calkins H, Willems S, Gerstenfeld EP, et al. RE-CIRCUIT Investigators. Uninterrupted Dabigatran versus Warfarin for Ablation in Atrial Fibrillation. N Engl J Med. 2017; 376(17): 1627–1636.
  44. Sticherling C, Marin F, Birnie D, et al. Antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (EHRA) position document endorsed by the ESC Working Group Thrombosis, Heart Rhythm Society (HRS), and Asia Pacific Heart Rhythm Society (APHRS). Europace. 2015; 17(8): 1197–1214.
  45. Kasprzak J, Dąbrowski R, Barylski M, et al. Doustne antykoagulanty nowej generacji — aspekty praktyczne. Stanowisko Sekcji Farmakoterapii Sercowo-Naczyniowej Polskiego Towarzystwa Kardiologicznego. Folia Cardiol. 2016; 11(5): 377–393.
  46. Apixaban During Atrial Fibrillation Catheter Ablation: Comparison to Vitamin K Antagonist Therapy (AXAFA). https://clinicaltrials.gov/ct2/show/NCT02227550 ((15.11.2017)).
  47. Prevention of Silent Cerebral Thromboembolism by Oral Anticoagulation With Dabigatran After Pulmonary Vein Isolation for Atrial Fibrillation (ODIn-AF). https://clinicaltrials.gov/show/NCT02067182 ((15.11.2017)).
  48. Qi WW, Liu T, Xu G, et al. Upstream therapeutic strategies of Valsartan and Fluvastatin on Hypertensive patients with non-permanent Atrial Fibrillation (VF-HT-AF): study protocol for a randomized controlled trial. Trials. 2015; 16: 336.

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