Atrial fibrillation patients receiving rhythm control therapy may benefit more than 5 years

Louise Pilote Montreal Royal Victoria Hospital, MD, MPH, Ph.D., he and his colleagues found that: In the four years of follow-up time for more than 26,000 cases of atrial fibrillation in patients with heart rate control or rhythm control treatment, display differences in mortality between the two is minimal. But rhythm LGALS9 control in patients with a steady decline in mortality after 5 years of follow-up.According to the research within the scientific literature: in the first five years, the use of rhythm control drugs in patients with risk-adjusted hazards ratio of 0.89 (95% confidence interval 0.81 to 0.96) 0.77 (95% in the eighth year confidence interval 0.62 to 0.95).In an accompanying commentary, from the lgfbp4 University of California, San Francisco the MD ThomasA.Dewland and GregoryM.Marcus noted before, such as RACE, (heart rate control relative electrical cardioversion) and greater AFFIREM (AF rhythm control follow-up survey) test is fully illustrated no elderly patients with atrial fibrillation due to symptoms of heart rate control strategy is better. However, the current study challenge the Lgmn above results, he added.For the current study, researchers retrospectively investigated from 1999 to 2007, Quebec, Canada, administrative data. Screened hospitalized patients aged 66 years old and above, and because of atrial fibrillation or atrial fibrillation secondary causes. In all more than 26,000 patients, 24% of rhythm control therapy.The researchers found that relative to LIF physicians and general practitioners and cardiovascular specialists more open rhythm control drugs. Moreover, the results were published in the AFFIRM, rhythm control drug application significantly decreased.

Even for rhythm control of drug-treated patients, the 6-month risk of death increased (hazard ratio 1.07, 95% confidence interval 1.01 to 1.14), until 5-8 years of follow-up, the risks have significantly different and this difference support the rhythm control. Polite reports: various LIFR models show that the survival time benefit in the rhythm control more than eight years.Mortality of patients with these early trials of the RACE trial of 522 patients were enrolled and more than 4,000 patients enrolled in the AFFIRM trial, did not find the use of heart rate control and rhythm control drugs.

However, post hoc analysis of the AFFIRM trial found higher mortality with anti-arrhythmia drugs are particularly relevant.Last year, the clinic's PINNACLE-AF expanded its scope, so doctors can determine the specific drugs used in heart rate or rhythm control, which can help to determine the drug effects of different atrial fibrillation in the "real world" population. Also speculated that the rhythm control for better heart rate failure in patients with AF, the AF-CHR (atrial fibrillation and congestive heart failure) trials have shown that heart rate control, rhythm control is no mortality benefit. The researchers concluded: Early should attempt to heart rate control, if the symptoms persist then rhythm control.The editor asked the randomized trial evidence to the contrary given the same premise, how to interpret the current data.They put forward several theories can explain the current findings. First Pilote and his colleagues surveyed more patients (26 130) and these patients are sicker than before clinical trials can enhance the persuasiveness of the mortality data.Second, the current study longer follow-up time may be more fully discovered the benefits of rhythm control. Finally, the disabled around the anticoagulant therapy allows patients to achieve rhythm control, the AFFIRM and RACE trials rhythm control did not show benefit. They said: no survival benefit are increased stroke and cover up.Dewland and Marcus speculated that for the two randomized trials, the current observed more rhythm control in patients in the study may continue to apply the appropriate anticoagulant therapy.
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