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Vol 6, No 2 (2004)
Prace oryginalne
Published online: 2004-06-23
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Sinus rhythm restoration and risk of stroke in patients with persistent atrial fibrillation

Dariusz A. Kosior, Danuta Filipczak, Sławomir Stawicki, Marek Kiliszek, Grzegorz Opolski
Udar Mózgu. Problemy Interdyscyplinarne 2004;6(2):39-46.

open access

Vol 6, No 2 (2004)
Prace oryginalne
Published online: 2004-06-23

Abstract

Background. The efficacy of oral anticoagulation in primary stroke prevention in pts with atrial fibrillation (AF) is well recognized. It is still unknown whether the strategy of cardioversion (CV) and efforts to maintain sinus rhythm (SR) in pts with persistent AF reduce effectively thromboembolic complications. Aim of the study was to assess impact of SR restoration on relative risk of systemic embolization episodes frequency in pts with persistent AF.
Material and methods. How To Treat Patients With Chronic Atrial Fibrillation (HOT CAFE Polish Study) was designed to evaluate in randomized, multicenter and prospective manner risks and advantages of two therapeutical strategies in patients (pts) with chronic atrial fibrillation (CAF): rate control vs. rhythm control. Inclusion criteria were: pts age 50-75 years, CAF lasting from 7 days up to 2 years with etiology of arrhythmia related to hypertension, ischemic heart disease and hemodynamic insignificant valvular heart disease or lack of assessable etiology (idiopathic AF). Our study population comparised 205 pts (F/M 71/134; mean age 60.8 ± 11.2 year). Observation period was 12 months.
Results. 104 pts (F/M 33/71; mean age 60.4 ± 7.9) were randomly assigned to rhythm control (group II). At the end of follow-up, 63.5% of pts remained in SR. Anticoagulation therapy was considered in all 101 pts (F/M 38/63; mean age 61.4 ± 17.6) assigned to the rate control group (group I) and there were no thromboembolic complications observed. Three pts suffered ischemic strokes in the rhythm control arm (NS). Two of them (1.9%), both resulting in death, were observed on the third day following successful CV. The third stroke (0.9%) which was not disabling, affected a patient with AF recurrence.
Conclusions. The strategy of SR restoration and maintenance in pts with persistent AF does not reduce the risk of thromboembolic complications.

Abstract

Background. The efficacy of oral anticoagulation in primary stroke prevention in pts with atrial fibrillation (AF) is well recognized. It is still unknown whether the strategy of cardioversion (CV) and efforts to maintain sinus rhythm (SR) in pts with persistent AF reduce effectively thromboembolic complications. Aim of the study was to assess impact of SR restoration on relative risk of systemic embolization episodes frequency in pts with persistent AF.
Material and methods. How To Treat Patients With Chronic Atrial Fibrillation (HOT CAFE Polish Study) was designed to evaluate in randomized, multicenter and prospective manner risks and advantages of two therapeutical strategies in patients (pts) with chronic atrial fibrillation (CAF): rate control vs. rhythm control. Inclusion criteria were: pts age 50-75 years, CAF lasting from 7 days up to 2 years with etiology of arrhythmia related to hypertension, ischemic heart disease and hemodynamic insignificant valvular heart disease or lack of assessable etiology (idiopathic AF). Our study population comparised 205 pts (F/M 71/134; mean age 60.8 ± 11.2 year). Observation period was 12 months.
Results. 104 pts (F/M 33/71; mean age 60.4 ± 7.9) were randomly assigned to rhythm control (group II). At the end of follow-up, 63.5% of pts remained in SR. Anticoagulation therapy was considered in all 101 pts (F/M 38/63; mean age 61.4 ± 17.6) assigned to the rate control group (group I) and there were no thromboembolic complications observed. Three pts suffered ischemic strokes in the rhythm control arm (NS). Two of them (1.9%), both resulting in death, were observed on the third day following successful CV. The third stroke (0.9%) which was not disabling, affected a patient with AF recurrence.
Conclusions. The strategy of SR restoration and maintenance in pts with persistent AF does not reduce the risk of thromboembolic complications.
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Keywords

atrial fibrillation; stroke; antiarrhythmic therapy; anticoagulation therapy

About this article
Title

Sinus rhythm restoration and risk of stroke in patients with persistent atrial fibrillation

Journal

Interdisciplinary Problems of Stroke

Issue

Vol 6, No 2 (2004)

Pages

39-46

Published online

2004-06-23

Bibliographic record

Udar Mózgu. Problemy Interdyscyplinarne 2004;6(2):39-46.

Keywords

atrial fibrillation
stroke
antiarrhythmic therapy
anticoagulation therapy

Authors

Dariusz A. Kosior
Danuta Filipczak
Sławomir Stawicki
Marek Kiliszek
Grzegorz Opolski

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