Key result
The choice of initial antiarrhythmic agent class (Ia, Ib, Ic, or III) did not affect the incidence of the primary composite endpoint.
Why the study?
Does the choice of initial antiarrhythmic agent class affect clinical outcomes in patients with paroxysmal atrial fibrillation?
Cohort (n=419)
Open-label
Yes
Does the choice of initial antiarrhythmic agent class affect clinical outcomes in patients with paroxysmal atrial fibrillation?
In patients with paroxysmal AF managed with rhythm control, the specific class of antiarrhythmic agent chosen initially did not significantly affect composite clinical outcomes or adjusted AF recurrence.
Answers are grounded in this paper and cite their sources.
Initial antiarrhythmic class choice was not associated with outcome differences in paroxysmal AF; leaves open need for randomized confirmation.
BACKGROUND: The J-RHYTHM (Japanese Rhythm Management Trial for Atrial Fibrillation) study demonstrated the benefit of rhythm-control compared with rate-control in Japanese patients with paroxysmal atrial fibrillation (AF), according to AF-specific quality of life scores. However, detailed information on prescribed antiarrhythmic agents remains unclear. METHODS AND RESULTS: Data for 419 patients enrolled in the rhythm-control arm of J-RHYTHM were analyzed. The primary endpoint was defined as a composite of total mortality, cerebral infarction, embolism, bleeding, heart failure, and physical/psychological disability. The secondary endpoint was recurrence of AF. The clinical outcome according to choice of initial antiarrhythmic agent (AA) was assessed by Kaplan-Meier survival curve, and further adjusted by Cox-regression hazard model. The primary endpoint occurred in 16.9%, 6.7%, 15.8% and 23.3% of patients assigned to class Ia, Ib, Ic and III agents (P=0.359). The rate of AF recurrence was significantly higher in patients taking a class III drug (Ia, Ib, Ic, III=20.3, 23.3, 29.1, 50.0%; P=0.002). However, after adjustment for other clinical variables, the choice of AA was not associated with recurrence of AF (class I vs III, P=0.15). CONCLUSIONS: The incidence of each endpoint did not differ according to the choice of AA. The class III drugs seemed to lower the sinus rhythm maintenance rate, which might be confounded by other comorbid conditions. (Circ J 2010; 74: 71 - 76).
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Aizawa et al. (2009) conducted a cohort in Paroxysmal atrial fibrillation (n=419). Vaughan Williams class Ia, Ib, Ic, or III antiarrhythmic agents vs. Compared among classes was evaluated on Composite of total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalization for heart failure, and physical/psychological disability (p=0.359). The choice of initial antiarrhythmic agent class (Ia, Ib, Ic, or III) did not affect the incidence of the primary composite endpoint.
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