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American Journal of Cardiology

Clinical Articles, Lead Article

Sustained AF more common with rate control

Rate control is the preferred treatment for recent-onset atrial fibrillation (AF) in the USA, but is associated with a greater level of progression to more sustained forms of AF than rhythm control, according to a study1 published recently in the American Journal of Cardiology.

The aims of the RecordAF (REgistry on Cardiac Rhythm DisORDers Assessing the Control of Atrial Fibrillation) study were to identify risk factors for AF progression and the effects of management approaches.

Researchers assessed AF progression at 12 months in the US cohort. AF progression was defined as a change of AF to a more sustained form (either paroxysmal becoming persistent or permanent, or persistent becoming permanent).

The US cohort included 955 patients, with mean age of 68.9 years; 56.8% were men and 88.8% were white. At entry, 59.6% of patients were selected for rate-control and 40.4% for rhythm-control therapy. At 12 months, the management strategy was unchanged for 68.2% of the patients in the rate- and 77.7% of the patients in the rhythm-control groups.

Overall, AF progression had occurred in 18.6% of patients at 12 months. The progression rate was significantly greater in the rate-control (27.6%) than in the rhythm-control (5.8%) group (p<0.001). Progression to permanent AF occurred in 16.4% of patients. In addition to a rate-control strategy, older age, AF rhythm at entry, persistent AF at baseline, and a history of stroke or transient ischaemic attack independently predicted AF progression.

Rate control was associated with AF progression, with a propensity score adjusted odds ratio of 2.67 (p<0.001). The authors conclude that although rate control was the preferred USA treatment, it was associated with more AF progression than rhythm control.

References

1. Zhang Y-Y, Qiu C, Davis PJ, Jhaveri M, Prystowsky EN, MD Kowey P, Weintraub WS. Predictors of progression of recently diagnosed atrial fibrillation in REgistry on Cardiac Rhythm DisORDers Assessing the Control of Atrial Fibrillation (RecordAF) – United States Cohort. Am J Cardiol 2013. http://dx.doi.org/10.1016/j.amjcard.2013.02.056

Published on: May 22, 2013

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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