Rationale and current perspective for early rhythm control therapy in atrial fibrillation

TY - JOUR

T1 - Rationale and current perspective for early rhythm control therapy in atrial fibrillation

AU - Van Gelder, Isabelle C

AU - Haegeli, Laurent M

AU - Brandes, Axel

AU - Heidbuchel, Hein

AU - Aliot, Etienne

AU - Kautzner, Josef

AU - Szumowski, Lukasz

AU - Mont, Lluis

AU - Morgan, John

AU - Willems, Stephan

AU - Themistoclakis, Sakis

AU - Gulizia, Michele

AU - Elvan, Arif

AU - Smit, Marcelle D

AU - Kirchhof, Paulus

PY - 2011/11

Y1 - 2011/11

N2 - Atrial fibrillation (AF) is the most common sustained arrhythmia and an important source for mortality and morbidity on a population level. Despite the clear association between AF and death, stroke, and other cardiovascular events, there is no evidence that rhythm control treatment improves outcome in AF patients. The poor outcome of rhythm control relates to the severity of the atrial substrate for AF not only due to the underlying atrial remodelling process but also due to the poor efficacy and adverse events of the currently available ion-channel antiarrhythmic drugs and ablation techniques. Data suggest, however, an association between sinus rhythm maintenance and improved survival. Hypothetically, sinus rhythm may also lead to a lower risk of stroke and heart failure. The presence of AF, thus, seems one of the modifiable factors associated with death and cardiovascular morbidity in AF patients. Patients with a short history of AF and the underlying heart disease have not been studied before. It is fair to assume that abolishment of AF in these patients is more successful and possibly also safer, which could translate into a prognostic benefit of early rhythm control therapy. Several trials are now investigating whether aggressive early rhythm control therapy can reduce cardiovascular morbidity and mortality and increase maintenance of sinus rhythm. In the present paper we describe the background of these studies and provide some information on their design.

AB - Atrial fibrillation (AF) is the most common sustained arrhythmia and an important source for mortality and morbidity on a population level. Despite the clear association between AF and death, stroke, and other cardiovascular events, there is no evidence that rhythm control treatment improves outcome in AF patients. The poor outcome of rhythm control relates to the severity of the atrial substrate for AF not only due to the underlying atrial remodelling process but also due to the poor efficacy and adverse events of the currently available ion-channel antiarrhythmic drugs and ablation techniques. Data suggest, however, an association between sinus rhythm maintenance and improved survival. Hypothetically, sinus rhythm may also lead to a lower risk of stroke and heart failure. The presence of AF, thus, seems one of the modifiable factors associated with death and cardiovascular morbidity in AF patients. Patients with a short history of AF and the underlying heart disease have not been studied before. It is fair to assume that abolishment of AF in these patients is more successful and possibly also safer, which could translate into a prognostic benefit of early rhythm control therapy. Several trials are now investigating whether aggressive early rhythm control therapy can reduce cardiovascular morbidity and mortality and increase maintenance of sinus rhythm. In the present paper we describe the background of these studies and provide some information on their design.

KW - Anti-Arrhythmia Agents/therapeutic use

KW - Atrial Fibrillation/complications

KW - Catheter Ablation

KW - Humans

KW - Risk Factors

KW - Secondary Prevention/trends

KW - Stroke/prevention & control

KW - Thromboembolism/prevention & control

KW - Treatment Outcome

U2 - 10.1093/europace/eur192

DO - 10.1093/europace/eur192

M3 - SCORING: Review article

C2 - 21784740

VL - 13

SP - 1517

EP - 1525

JO - EUROPACE

JF - EUROPACE

SN - 1099-5129

IS - 11

ER -