Key result
Rhythm control is linked to ~53% fewer major events vs rate control in asymptomatic AF.
Why the study?
Rhythm control improves cardiovascular outcomes in AF, but outcomes across baseline symptom scores and the optimal treatment strategy for asymptomatic AF were unclear.
Does a rhythm control strategy reduce the composite of hospitalization for heart failure, ischemic stroke, or cardiac death in asymptomatic patients with atrial fibrillation?
Observational (n=1,515)
Yes
Does a rhythm control strategy reduce the composite of hospitalization for heart failure, ischemic stroke, or cardiac death in asymptomatic patients with atrial fibrillation?
A rhythm control strategy significantly reduces the risk of adverse cardiovascular outcomes in asymptomatic patients with atrial fibrillation, particularly those with paroxysmal AF, smaller left atrium size, or higher stroke risk.
Answers are grounded in this paper and cite their sources.
Should not yet change practice in asymptomatic AF; hypothesis-generating extension of rhythm control benefit beyond symptomatic patients.
Background Atrial fibrillation (AF) is associated with an increased risk of poor cardiovascular outcomes; appropriate rhythm control can reduce the incidence of these adverse events. Therefore, catheter ablation is recommended in symptomatic patients with AF. The aims of this study were to compare AF‐related outcomes according to a baseline symptom scale score and to determine the best treatment strategy for asymptomatic patients with AF. Methods and Results This study enrolled all patients who completed a baseline Atrial Fibrillation Effect on Quality‐of‐Life (AFEQT) survey in a prospective observational registry. The patients were divided into 2 groups according to AFEQT score at baseline; scores ≤80 were defined as symptomatic, whereas scores >80 represented asymptomatic patients. The primary outcome was defined as a composite of hospitalization for heart failure, ischemic stroke, or cardiac death. This study included 1515 patients (mean age: 65.7±10.5 years; 998 [65.9%] men). The survival curve showed a poorer outcome in the symptomatic group compared with the asymptomatic group (log‐rank P =0.04). Rhythm control led to a significantly lower risk of a composite outcome in asymptomatic patients (hazard ratio [HR], 0.47 [95% CI, 0.27–0.84], P =0.01). Rhythm control was associated with more favorable composite outcomes in the asymptomatic group with paroxysmal AF, left atrium diameter ≤50 mm, and CHA 2 DS 2 ‐VASc score ≥3. Conclusions Symptomatic patients with AF experienced more adverse outcomes compared with asymptomatic patients. In asymptomatic patients with AF, a strategy of rhythm control improved the outcomes, especially with paroxysmal AF, smaller left atrium size, or higher stroke risk. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02786095.
No takes yet. Share an insight, caveat, or question.
Kim et al. (2022) conducted an observational in Atrial Fibrillation (n=1,515). Rhythm control strategy vs. Rate control strategy was evaluated on Composite of hospitalization for heart failure, ischemic stroke, or cardiac death (HR 0.47, 95% CI 0.27-0.84, p=0.01). In asymptomatic patients with atrial fibrillation, a rhythm control strategy significantly reduced the risk of a composite of heart failure hospitalization, ischemic stroke, or cardiac death compared with rate control (HR 0.47).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: