Rationale and current perspective for early rhythm control therapy in atrial fibrillation
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Rationale and current perspective for early rhythm control therapy in atrial fibrillation. / Van Gelder, Isabelle C; Haegeli, Laurent M; Brandes, Axel; Heidbuchel, Hein; Aliot, Etienne; Kautzner, Josef; Szumowski, Lukasz; Mont, Lluis; Morgan, John; Willems, Stephan; Themistoclakis, Sakis; Gulizia, Michele; Elvan, Arif; Smit, Marcelle D; Kirchhof, Paulus.
In: EUROPACE, Vol. 13, No. 11, 11.2011, p. 1517-1525.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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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 -