Rhythm control for patients with atrial fibrillation complicated with heart failure in the contemporary era of catheter ablation: a stratified pooled analysis of randomized data
Abstract Aims The optimal treatment for patients with atrial fibrillation (AF) and heart failure (HF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of rhythm control strategy in patients with AF complicated with HF regarding hard clinical endpoints. Methods and...
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| Veröffentlicht in: | European heart journal 2020-08, Vol.41 (30), p.2863-2873 |
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| creator | Chen, Shaojie Pürerfellner, Helmut Meyer, Christian Acou, Willem-Jan Schratter, Alexandra Ling, Zhiyu Liu, Shaowen Yin, Yuehui Martinek, Martin Kiuchi, Marcio G Schmidt, Boris Chun, K R Julian |
| description | Abstract
Aims
The optimal treatment for patients with atrial fibrillation (AF) and heart failure (HF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of rhythm control strategy in patients with AF complicated with HF regarding hard clinical endpoints.
Methods and results
Up-to-date randomized data comparing rhythm control using antiarrhythmic drugs (AADs) vs. rate control (Subset A) or rhythm control using catheter ablation vs. medical therapy (Subset B) in AF and HF patients were pooled. The primary outcomes were all-cause mortality, re-hospitalization, stroke, and thromboembolic events. A total of 11 studies involving 3598 patients were enrolled (Subset A: 2486; Subset B: 1112). As compared with medical rate control, the AADs rhythm control was associated with similar all-cause mortality [odds ratio (OR): 0.96, P = 0.65], significantly higher rate of re-hospitalization (OR: 1.25, P = 0.01), and similar rate of stroke and thromboembolic events (OR: 0.91, P = 0.76,); however, as compared with medical therapy, catheter ablation rhythm control was associated with significantly lower all-cause mortality (OR: 0.51, P = 0.0003), reduced re-hospitalization rate (OR: 0.44, P = 0.003), similar rate of stroke events (OR: 0.59, P = 0.27), greater improvement in left ventricular ejection fraction [weighted mean difference (WMD): 6.8%, P = 0.0004], lower arrhythmia recurrence (29.6% vs. 80.1%, OR: 0.04, P |
| doi_str_mv | 10.1093/eurheartj/ehz443 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2257702384</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/eurheartj/ehz443</oup_id><sourcerecordid>2257702384</sourcerecordid><originalsourceid>FETCH-LOGICAL-c265t-e8f51da0b880ac0a0092dc0c1e5b6062fb522c7f05aac00474b01f426e425cf93</originalsourceid><addsrcrecordid>eNqFkc1q3TAQhUVpaW7T7rMKWhaKm5Fs6drZhUv6A4FCaaE7M5ZHWMG2XEkm3LxV37BKnGbb1Qid7xykOYydCfgooCkvaA0DYUi3FzTcV1X5gu2EkrJodKVesh2IRhVa179O2JsYbwGg1kK_ZielkE0ttd6xP9-HYxombvycgh-59YEvmBzNKfI7lwaOKTjMguuCG8cs-TnT0zI6g4n6DXp8BbfoxjUQdzNPAz1m0rT4gOHIKSD3lmfPQIkCx27LuuTIYwr5bF1OW7wf88AZx2N08cEScO795O7zdY8J37JXFsdI757mKfv56frH4Utx8-3z18PVTWGkVqmg2irRI3R1DWgAARrZGzCCVKdBS9vlRZm9BYVZhmpfdSBsJTVVUhnblKfs_Za7BP97pZjayUVDeQUz-TW2Uqr9HmRZVxmFDTXBxxjItktwU_51K6B9KKp9LqrdisqW86f0tZuofzb8ayYDHzbAr8v_4_4C9Fqm2A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2257702384</pqid></control><display><type>article</type><title>Rhythm control for patients with atrial fibrillation complicated with heart failure in the contemporary era of catheter ablation: a stratified pooled analysis of randomized data</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Chen, Shaojie ; Pürerfellner, Helmut ; Meyer, Christian ; Acou, Willem-Jan ; Schratter, Alexandra ; Ling, Zhiyu ; Liu, Shaowen ; Yin, Yuehui ; Martinek, Martin ; Kiuchi, Marcio G ; Schmidt, Boris ; Chun, K R Julian</creator><creatorcontrib>Chen, Shaojie ; Pürerfellner, Helmut ; Meyer, Christian ; Acou, Willem-Jan ; Schratter, Alexandra ; Ling, Zhiyu ; Liu, Shaowen ; Yin, Yuehui ; Martinek, Martin ; Kiuchi, Marcio G ; Schmidt, Boris ; Chun, K R Julian</creatorcontrib><description>Abstract
Aims
The optimal treatment for patients with atrial fibrillation (AF) and heart failure (HF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of rhythm control strategy in patients with AF complicated with HF regarding hard clinical endpoints.
Methods and results
Up-to-date randomized data comparing rhythm control using antiarrhythmic drugs (AADs) vs. rate control (Subset A) or rhythm control using catheter ablation vs. medical therapy (Subset B) in AF and HF patients were pooled. The primary outcomes were all-cause mortality, re-hospitalization, stroke, and thromboembolic events. A total of 11 studies involving 3598 patients were enrolled (Subset A: 2486; Subset B: 1112). As compared with medical rate control, the AADs rhythm control was associated with similar all-cause mortality [odds ratio (OR): 0.96, P = 0.65], significantly higher rate of re-hospitalization (OR: 1.25, P = 0.01), and similar rate of stroke and thromboembolic events (OR: 0.91, P = 0.76,); however, as compared with medical therapy, catheter ablation rhythm control was associated with significantly lower all-cause mortality (OR: 0.51, P = 0.0003), reduced re-hospitalization rate (OR: 0.44, P = 0.003), similar rate of stroke events (OR: 0.59, P = 0.27), greater improvement in left ventricular ejection fraction [weighted mean difference (WMD): 6.8%, P = 0.0004], lower arrhythmia recurrence (29.6% vs. 80.1%, OR: 0.04, P < 0.00001), and greater improvement in quality of life (Minnesota Living with Heart Failure Questionnaire score) (WMD: −9.1, P = 0.007).
Conclusion
Catheter ablation as rhythm control strategy substantially improves survival rate, reduces re-hospitalization, increases the maintenance rate of sinus rhythm, contributes to preserve cardiac function, and improves quality of life for AF patients complicated with HF.</description><identifier>ISSN: 0195-668X</identifier><identifier>ISSN: 1522-9645</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehz443</identifier><identifier>PMID: 31298266</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Anti-Arrhythmia Agents - therapeutic use ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - therapy ; Catheter Ablation ; Heart Failure - drug therapy ; Heart Failure - therapy ; Humans ; Minnesota ; Quality of Life ; Stroke Volume ; Treatment Outcome ; Ventricular Function, Left</subject><ispartof>European heart journal, 2020-08, Vol.41 (30), p.2863-2873</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com. 2019</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c265t-e8f51da0b880ac0a0092dc0c1e5b6062fb522c7f05aac00474b01f426e425cf93</citedby><cites>FETCH-LOGICAL-c265t-e8f51da0b880ac0a0092dc0c1e5b6062fb522c7f05aac00474b01f426e425cf93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31298266$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Shaojie</creatorcontrib><creatorcontrib>Pürerfellner, Helmut</creatorcontrib><creatorcontrib>Meyer, Christian</creatorcontrib><creatorcontrib>Acou, Willem-Jan</creatorcontrib><creatorcontrib>Schratter, Alexandra</creatorcontrib><creatorcontrib>Ling, Zhiyu</creatorcontrib><creatorcontrib>Liu, Shaowen</creatorcontrib><creatorcontrib>Yin, Yuehui</creatorcontrib><creatorcontrib>Martinek, Martin</creatorcontrib><creatorcontrib>Kiuchi, Marcio G</creatorcontrib><creatorcontrib>Schmidt, Boris</creatorcontrib><creatorcontrib>Chun, K R Julian</creatorcontrib><title>Rhythm control for patients with atrial fibrillation complicated with heart failure in the contemporary era of catheter ablation: a stratified pooled analysis of randomized data</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Abstract
Aims
The optimal treatment for patients with atrial fibrillation (AF) and heart failure (HF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of rhythm control strategy in patients with AF complicated with HF regarding hard clinical endpoints.
Methods and results
Up-to-date randomized data comparing rhythm control using antiarrhythmic drugs (AADs) vs. rate control (Subset A) or rhythm control using catheter ablation vs. medical therapy (Subset B) in AF and HF patients were pooled. The primary outcomes were all-cause mortality, re-hospitalization, stroke, and thromboembolic events. A total of 11 studies involving 3598 patients were enrolled (Subset A: 2486; Subset B: 1112). As compared with medical rate control, the AADs rhythm control was associated with similar all-cause mortality [odds ratio (OR): 0.96, P = 0.65], significantly higher rate of re-hospitalization (OR: 1.25, P = 0.01), and similar rate of stroke and thromboembolic events (OR: 0.91, P = 0.76,); however, as compared with medical therapy, catheter ablation rhythm control was associated with significantly lower all-cause mortality (OR: 0.51, P = 0.0003), reduced re-hospitalization rate (OR: 0.44, P = 0.003), similar rate of stroke events (OR: 0.59, P = 0.27), greater improvement in left ventricular ejection fraction [weighted mean difference (WMD): 6.8%, P = 0.0004], lower arrhythmia recurrence (29.6% vs. 80.1%, OR: 0.04, P < 0.00001), and greater improvement in quality of life (Minnesota Living with Heart Failure Questionnaire score) (WMD: −9.1, P = 0.007).
Conclusion
Catheter ablation as rhythm control strategy substantially improves survival rate, reduces re-hospitalization, increases the maintenance rate of sinus rhythm, contributes to preserve cardiac function, and improves quality of life for AF patients complicated with HF.</description><subject>Anti-Arrhythmia Agents - therapeutic use</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Atrial Fibrillation - therapy</subject><subject>Catheter Ablation</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - therapy</subject><subject>Humans</subject><subject>Minnesota</subject><subject>Quality of Life</subject><subject>Stroke Volume</subject><subject>Treatment Outcome</subject><subject>Ventricular Function, Left</subject><issn>0195-668X</issn><issn>1522-9645</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1q3TAQhUVpaW7T7rMKWhaKm5Fs6drZhUv6A4FCaaE7M5ZHWMG2XEkm3LxV37BKnGbb1Qid7xykOYydCfgooCkvaA0DYUi3FzTcV1X5gu2EkrJodKVesh2IRhVa179O2JsYbwGg1kK_ZielkE0ttd6xP9-HYxombvycgh-59YEvmBzNKfI7lwaOKTjMguuCG8cs-TnT0zI6g4n6DXp8BbfoxjUQdzNPAz1m0rT4gOHIKSD3lmfPQIkCx27LuuTIYwr5bF1OW7wf88AZx2N08cEScO795O7zdY8J37JXFsdI757mKfv56frH4Utx8-3z18PVTWGkVqmg2irRI3R1DWgAARrZGzCCVKdBS9vlRZm9BYVZhmpfdSBsJTVVUhnblKfs_Za7BP97pZjayUVDeQUz-TW2Uqr9HmRZVxmFDTXBxxjItktwU_51K6B9KKp9LqrdisqW86f0tZuofzb8ayYDHzbAr8v_4_4C9Fqm2A</recordid><startdate>20200807</startdate><enddate>20200807</enddate><creator>Chen, Shaojie</creator><creator>Pürerfellner, Helmut</creator><creator>Meyer, Christian</creator><creator>Acou, Willem-Jan</creator><creator>Schratter, Alexandra</creator><creator>Ling, Zhiyu</creator><creator>Liu, Shaowen</creator><creator>Yin, Yuehui</creator><creator>Martinek, Martin</creator><creator>Kiuchi, Marcio G</creator><creator>Schmidt, Boris</creator><creator>Chun, K R Julian</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20200807</creationdate><title>Rhythm control for patients with atrial fibrillation complicated with heart failure in the contemporary era of catheter ablation: a stratified pooled analysis of randomized data</title><author>Chen, Shaojie ; Pürerfellner, Helmut ; Meyer, Christian ; Acou, Willem-Jan ; Schratter, Alexandra ; Ling, Zhiyu ; Liu, Shaowen ; Yin, Yuehui ; Martinek, Martin ; Kiuchi, Marcio G ; Schmidt, Boris ; Chun, K R Julian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c265t-e8f51da0b880ac0a0092dc0c1e5b6062fb522c7f05aac00474b01f426e425cf93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anti-Arrhythmia Agents - therapeutic use</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Atrial Fibrillation - therapy</topic><topic>Catheter Ablation</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - therapy</topic><topic>Humans</topic><topic>Minnesota</topic><topic>Quality of Life</topic><topic>Stroke Volume</topic><topic>Treatment Outcome</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Shaojie</creatorcontrib><creatorcontrib>Pürerfellner, Helmut</creatorcontrib><creatorcontrib>Meyer, Christian</creatorcontrib><creatorcontrib>Acou, Willem-Jan</creatorcontrib><creatorcontrib>Schratter, Alexandra</creatorcontrib><creatorcontrib>Ling, Zhiyu</creatorcontrib><creatorcontrib>Liu, Shaowen</creatorcontrib><creatorcontrib>Yin, Yuehui</creatorcontrib><creatorcontrib>Martinek, Martin</creatorcontrib><creatorcontrib>Kiuchi, Marcio G</creatorcontrib><creatorcontrib>Schmidt, Boris</creatorcontrib><creatorcontrib>Chun, K R Julian</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Shaojie</au><au>Pürerfellner, Helmut</au><au>Meyer, Christian</au><au>Acou, Willem-Jan</au><au>Schratter, Alexandra</au><au>Ling, Zhiyu</au><au>Liu, Shaowen</au><au>Yin, Yuehui</au><au>Martinek, Martin</au><au>Kiuchi, Marcio G</au><au>Schmidt, Boris</au><au>Chun, K R Julian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rhythm control for patients with atrial fibrillation complicated with heart failure in the contemporary era of catheter ablation: a stratified pooled analysis of randomized data</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2020-08-07</date><risdate>2020</risdate><volume>41</volume><issue>30</issue><spage>2863</spage><epage>2873</epage><pages>2863-2873</pages><issn>0195-668X</issn><issn>1522-9645</issn><eissn>1522-9645</eissn><abstract>Abstract
Aims
The optimal treatment for patients with atrial fibrillation (AF) and heart failure (HF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of rhythm control strategy in patients with AF complicated with HF regarding hard clinical endpoints.
Methods and results
Up-to-date randomized data comparing rhythm control using antiarrhythmic drugs (AADs) vs. rate control (Subset A) or rhythm control using catheter ablation vs. medical therapy (Subset B) in AF and HF patients were pooled. The primary outcomes were all-cause mortality, re-hospitalization, stroke, and thromboembolic events. A total of 11 studies involving 3598 patients were enrolled (Subset A: 2486; Subset B: 1112). As compared with medical rate control, the AADs rhythm control was associated with similar all-cause mortality [odds ratio (OR): 0.96, P = 0.65], significantly higher rate of re-hospitalization (OR: 1.25, P = 0.01), and similar rate of stroke and thromboembolic events (OR: 0.91, P = 0.76,); however, as compared with medical therapy, catheter ablation rhythm control was associated with significantly lower all-cause mortality (OR: 0.51, P = 0.0003), reduced re-hospitalization rate (OR: 0.44, P = 0.003), similar rate of stroke events (OR: 0.59, P = 0.27), greater improvement in left ventricular ejection fraction [weighted mean difference (WMD): 6.8%, P = 0.0004], lower arrhythmia recurrence (29.6% vs. 80.1%, OR: 0.04, P < 0.00001), and greater improvement in quality of life (Minnesota Living with Heart Failure Questionnaire score) (WMD: −9.1, P = 0.007).
Conclusion
Catheter ablation as rhythm control strategy substantially improves survival rate, reduces re-hospitalization, increases the maintenance rate of sinus rhythm, contributes to preserve cardiac function, and improves quality of life for AF patients complicated with HF.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>31298266</pmid><doi>10.1093/eurheartj/ehz443</doi><tpages>11</tpages></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Anti-Arrhythmia Agents - therapeutic use Atrial Fibrillation - drug therapy Atrial Fibrillation - therapy Catheter Ablation Heart Failure - drug therapy Heart Failure - therapy Humans Minnesota Quality of Life Stroke Volume Treatment Outcome Ventricular Function, Left |
| title | Rhythm control for patients with atrial fibrillation complicated with heart failure in the contemporary era of catheter ablation: a stratified pooled analysis of randomized data |
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