The year in cardiology 2017: arrhythmias and cardiac devices
Key result
AF ablation cuts worsening HF or all-cause death by ~38% versus medical therapy.
- HR 0.62
- 95% CI 0.43-0.87
- P=0.007
Population
Patients with cardiac arrhythmias, including atrial fibrillation and AVNRT, and those with cardiac devices.
Comparison
Various therapies including catheter ablation… vs Conventional medical therapy or antiarrhythmic…
Design
Review
Authors
Discussion
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Implication
Provides 2017 arrhythmia overview; leaves open need for prospective validation of summarized advances.
Key Points
- To synthesize and contextualize major clinical trials, registry findings, and technological innovations in arrhythmia management and cardiac devices reported throughout 2017.
- Reviewed outcomes from landmark randomized controlled trials and prospective multicenter registries published or presented in 2017.
- Evaluated diagnostic and therapeutic strategies including antiarrhythmic medications, catheter ablation, device-detected atrial high-rate monitoring, and non-vitamin K antagonist oral anticoagulants.
- Examined structural interventions and device therapies, including implantable loop recorders, cardiac resynchronization therapy, and implantable cardioverter defibrillators.
- In CASTLE-AF (N=363, LVEF ≤ 35%), catheter ablation of atrial fibrillation significantly reduced the primary composite of worsening heart failure or all-cause mortality compared to medical therapy (HR 0.62, 95% CI 0.43–0.87; P=0.007).
- The RACE 3 trial demonstrated that comprehensive upstream therapy improved maintenance of sinus rhythm at 1 year in persistent atrial fibrillation compared to conventional rhythm control (75% vs. 63%, P=0.02).
- Analysis from the ASSERT trial established that subclinical device-detected atrial fibrillation was associated with elevated stroke risk when episodes exceeded 24 hours, but not for shorter durations.
Structured PICO
P
Population
Patients with cardiac arrhythmias, including atrial fibrillation and AVNRT, and those with cardiac devices.
I
Intervention
Various therapies including catheter ablation, anticoagulation, and lifestyle modifications.
C
Comparator
Conventional medical therapy or antiarrhythmic drugs.
This 2017 year-in-review highlights major advancements in electrophysiology, including the mortality benefit of AF ablation in heart failure and the importance of lifestyle modifications.
Cite This Study
Linde et al. (2017) conducted a review in Cardiac arrhythmias. Arrhythmia and cardiac device therapies was evaluated. Cardiac arrhythmia interventions reviewed in 2017 included atrial fibrillation ablation, which reduced the composite of worsening heart failure or all-cause death (HR 0.62; 95% CI 0.43-0.87; P=0.007).