Contemporary real life cardioversion of atrial fibrillation: Results from the multinational RHYTHM-AF study

被引:87
作者
Crijns, Harry J. G. M. [1 ,2 ]
Weijs, Bob [1 ,2 ]
Fairley, Anna-Meagan [1 ,2 ]
Lewalter, Thorsten [3 ]
Maggioni, Aldo P. [4 ]
Martin, Alfonso [5 ]
Ponikowski, Piotr [6 ]
Rosenqvist, Marten [7 ]
Sanders, Prashanthan [8 ,9 ]
Scanavacca, Mauricio [10 ]
Bash, Lori D. [11 ]
Chazelle, Francois [12 ]
Bernhardt, Alexandra [13 ]
Gitt, Anselm K. [13 ]
Lip, Gregory Y. H. [14 ]
Le Heuzey, Jean-Yves [15 ]
机构
[1] Maastricht Univ, Med Ctr, Dept Cardiol, NL-6202 AZ Maastricht, Netherlands
[2] Maastricht Univ, Med Ctr, Cardiovasc Res Inst Maastricht CARIM, NL-6202 AZ Maastricht, Netherlands
[3] Univ Bonn, Bonn, Germany
[4] ANMCO Res Ctr, Florence, Italy
[5] Univ Hosp Severo Ochoa, Madrid, Spain
[6] Med Univ, Wroclaw, Poland
[7] Karolinska Inst, Stockholm, Sweden
[8] Univ Adelaide, Ctr Heart Rhythm Disorders, Adelaide, SA, Australia
[9] Royal Adelaide Hosp, Adelaide, SA 5000, Australia
[10] Univ Sao Paulo, Sao Paulo, Brazil
[11] Merck Sharp & Dohme Corp, Whitehouse Stn, NJ USA
[12] MSD France, Paris, France
[13] Inst Herzinfarktforsch, Ludwigshafen, Germany
[14] Univ Birmingham, Ctr Cardiovasc Sci, Dept Cardiol, City Hosp, Birmingham, W Midlands, England
[15] Univ Paris 05, Hop Europeen Georges Pompidou, Paris, France
关键词
Atrial fibrillation; Cardioversion; Rhythm control; Stroke; ELECTRICAL CARDIOVERSION; MANAGEMENT; FLECAINIDE; REGISTRY;
D O I
10.1016/j.ijcard.2014.01.099
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims: Electrical and pharmacological cardioversion (ECV, PCV) are important treatment options for symptomatic patients with recent onset atrial fibrillation (AF). RHYTHM-AF is an international registry of present-day cardioversion providing information that is not currently available on country differences and acute and long-term arrhythmia outcomes of ECV and PCV. Methods and results: 3940 patients were enrolled, of whom 75% underwent CV. All patients were followed for 2 months. There were large variations concerning mode of CV used, ECV being heterogeneous. A choice of PCV drug depended on the clinical patient profile. Sinus rhythm was restored in 89.7% of patients by ECV and in 69.1% after PCV. Among patients not undergoing CV during admission, 34% spontaneously converted to sinus rhythmwithin 24 h. ECV was most successful in patients pretreated with antiarrhythmic drugs (mostly amiodarone). PCV was enhanced by class Ic antiarrhythmic drugs; conversion rate on amiodarone was similar to that seen with rate control drugs. Female patients and those with paroxysmal and first detected AF as well as those without previous ECV responded well to PCV. The median duration of hospital stay was 16.2 and 24.0 h for ECV and PCV patients, respectively. There were very few CV-related complications regardless of mode of CV. Chronic maintenance of sinus rhythm was enhanced in patients on chronic antiarrhythmic drugs, beta-blockers or inhibitors of the renin-angiotensin system. Conclusions: Mode of CV varied significantly, but both PCV and ECV were safe and effective. Class Ic drugs were most effective conversion drugs, but amiodarone is used most frequently despite providing merely rate control rather than shorten time to conversion. (c) 2014 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:588 / 594
页数:7
相关论文
共 21 条
[1]   Continuous vs episodic prophylactic treatment with amiodarone for the prevention of atrial fibrillation - A randomized trial [J].
Ahmed, Sheba ;
Rienstra, Michiel ;
Crijns, Harry J. G. M. ;
Links, Thera P. ;
Wiesfeld, Ans C. P. ;
Hillege, Hans L. ;
Bosker, Hans A. ;
Lok, Dirk J. A. ;
Van Veldhuisen, Dirk J. ;
Van Gelder, Isabelle C. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2008, 300 (15) :1784-1792
[2]   Outpatient treatment of recent-onset atrial fibrillation with the "pill-in-the-pocket'' approach [J].
Alboni, P ;
Botto, GL ;
Baldi, N ;
Luzi, M ;
Russo, V ;
Gianfranchi, L ;
Marchi, P ;
Calzolari, M ;
Solano, A ;
Baroffio, R ;
Gaggioli, G .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 351 (23) :2384-2391
[3]   Intravenous administration of flecainide or propafenone in patients with recent-onset atrial fibrillation does not predict adverse effects during 'pill-in-the-pocket' treatment [J].
Alboni, Paolo ;
Botto, Giovanni L. ;
Boriani, Giuseppe ;
Russo, Giovanni ;
Pacchioni, Federico ;
Iori, Matteo ;
Pasanisi, Giovanni ;
Mancini, Marina ;
Mariconti, Barbara ;
Capucci, Alessandro .
HEART, 2010, 96 (07) :546-549
[4]   CONTROLLING THE FALSE DISCOVERY RATE - A PRACTICAL AND POWERFUL APPROACH TO MULTIPLE TESTING [J].
BENJAMINI, Y ;
HOCHBERG, Y .
JOURNAL OF THE ROYAL STATISTICAL SOCIETY SERIES B-STATISTICAL METHODOLOGY, 1995, 57 (01) :289-300
[5]   Real-Life Observations of Clinical Outcomes With Rhythm- and Rate-Control Therapies for Atrial Fibrillation RECORDAF (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation) [J].
Camm, A. John ;
Breithardt, Guenter ;
Crijns, Harry ;
Dorian, Paul ;
Kowey, Peter ;
Le Heuzey, Jean-Yves ;
Merioua, Ihsen ;
Pedrazzini, Laurence ;
Prystowsky, Eric N. ;
Schwartz, Peter J. ;
Torp-Pedersen, Christian ;
Weintraub, William .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2011, 58 (05) :493-501
[6]  
Camm AJ, 2010, EUROPACE, V12, P1360, DOI [10.1093/europace/euq350, 10.1093/eurheartj/ehq278]
[7]   RHYTHM-AF: design of an international registry on cardioversion of atrial fibrillation and characteristics of participating centers [J].
Crijns, Harry J. G. M. ;
Bash, Lori D. ;
Chazelle, Francois ;
Le Heuzey, Jean-Yves ;
Lewalter, Thorsten ;
Lip, Gregory Y. H. ;
Maggioni, Aldo P. ;
Martin, Alfonso ;
Ponikowski, Piotr ;
Rosenqvist, Marten ;
Sanders, Prashanthan ;
Scanavacca, Mauricio ;
Bernhardt, Alexandra A. ;
Unniachan, Sreevalsa ;
Phatak, Hemant M. ;
Gitt, Anselm K. .
BMC CARDIOVASCULAR DISORDERS, 2012, 12
[8]   ACUTE CONVERSION OF ATRIAL-FIBRILLATION TO SINUS RHYTHM - CLINICAL EFFICACY OF FLECAINIDE ACETATE - COMPARISON OF 2 REGIMENS [J].
CRIJNS, HJGM ;
VANWIJK, LM ;
VANGILST, WH ;
KINGMA, JH ;
VANGELDER, IC ;
LIE, KI .
EUROPEAN HEART JOURNAL, 1988, 9 (06) :634-638
[9]   Analysis of current management of atrial fibrillation in the acute setting:: GEFAUR-1 study [J].
del Arco, C ;
Martín, A ;
Laguna, P ;
Gargantilla, P .
ANNALS OF EMERGENCY MEDICINE, 2005, 46 (05) :424-430
[10]   Clinical challenge .2. Management of recent onset atrial fibrillation [J].
Fresco, C ;
Proclemer, A .
EUROPEAN HEART JOURNAL, 1996, 17 :41-47