Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access |
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc |
Journal website http://www.cardiologyres.org |
Original Article
Volume 10, Number 2, April 2019, pages 98-105
Rate Control Yields Better Clinical Outcomes Over a Median Follow-Up of 20 Months Compared to Rhythm Control Strategy in Patients With a History of Atrial Fibrillation: A Retrospective Cohort Study
Figures
Tables
Therapeutic regimen | Catheter ablation (n = 74) | Rate control strategy (n = 60) | Rhythm control strategy (n = 41) |
---|---|---|---|
AF: atrial fibrillation; BMI: body mass index; IQR: interquartile range; SD: standard deviation; TIA: transient ischemic attack. | |||
Age (years), median (IQR) | 62 (54 - 70) | 63 (56 - 63) | 63 (55 - 64) |
Male gender, n (%) | 53 (72%) | 44 (74%) | 27 (65.8%) |
BMI (kg/m2), mean ± SD | 27.3 ± 4 | 27.3 ± 4 | 29 ± 5 |
Paroxysmal AF, n (%) | 74 (100%) | 47 (78.3%) | 32 (78%) |
Prior cardioversion, n (%) | 18 (24%) | 14 (23.3%) | 25 (60.9%) |
AF history (months), median (IQR) | 26 (12 - 81) | 26 (7 - 84) | 26 (12–81) |
Antero-posterior left atrial diameter (mm), mean ± SD | 42 ± 4 | 43 ± 5 | 43 ± 6 |
Hypertension, n (%) | 33 (44.6 %) | 27 (45%) | 17 (41.5%) |
Left ventricular ejection fraction (%) | 56 | 50 | 52 |
Previous TIA/stroke, n (%) | 6 (8%) | 5 (8%) | 5 (12.2%) |
Diabetes, n (%) | 3 (4.05%) | 3 (5%) | 3 (7.3%) |
History of typical atrial flutter, n (%) | 16 (21.62%) | 7 (11.6 %) | 8 (19.5%) |
CHA2DS2-VASc score > 2, n (%) | 15 (20.2%) | 12 (20%) | 9 (21.95%) |
At least 1 AF episode, n (%) | |||
Per 3 months | 17 (22.9 %) | 23 (38.3 %) | 9 (21.95%) |
Per month | 17 (23%) | 22 (36.6 %) | 8 (19.5%) |
Per week | 12 (16.2%) | 15 (25%) | 5 (12.2%) |
Per day | 5 (6.7%) | 9 (15%) | 3 (7.3%) |
Covariate | b | SE | P | Hazard ratio (HR) | 95% CI of HR |
---|---|---|---|---|---|
*Indicating the variable has a significant meaning of protective factor (rate control strategy), or vice versa, that it is a predictor of increased risk (No. of AF recurrences during the follow-up, rhythm control strategy, and hypertension) with regard to composite of death, disabling stroke, severe bleeding and cardiac arrest. Catheter ablation is not a predictor of improved clinical outcomes in the mid-term (median follow-up: 20 months), in spite of its efficacy in suppressing atrial tachyarrhythmias. b: regression coefficient; SE: standard error of b; AF: atrial fibrillation; CI: confidence interval; IC drugs: antiarrhythmic drugs belonging to class IC of the Vaughan-Williams classification; LVEF: left ventricular ejection fraction. | |||||
No. AF recurrences during follow-up | 0.0438 | 0.0214 | 0.0410* | 1.0448* | 1.0020 to 1.0895* |
Time to first AF recurrence (days) | 0.0016 | 0.0017 | 0.3642 | 1.0016 | 0.9982 to 1. 0051 |
Catheter ablation (0 = isolated ablation; 1 = ablation followed by IC drugs or sotalol) | 11.1241 | 185.6959 | 0.1522 | 1.0015 | 0.9983 to 1.0046 |
Rate control strategy (2 = atenolol; 3 = verapamil) | -2.6433 | 0.8510 | 0.0019* | 0.0711* | 0.0135 to 0.3738* |
Rhythm control strategy (4 = sotalol; 5 = propafenone; 6 = flecainide) | 1.1987 | 0.3928 | 0.0023* | 3.3159* | 1.5415 to 7.1329* |
Antero-posterior left atrial diameter | -0.2567 | 0.2842 | 0.3663 | 0.7736 | 0.4445 to 1.3464 |
LVEF (%) | 0.0542 | 0.0677 | 0.4239 | 1.0557 | 0.9250 to 1.2049 |
Hypertension | 2.2629 | 1.1428 | 0.0477* | 1.1040* | 1.0112 to 1.9662* |
Death | Disabling stroke | Major bleeding | Cardiac arrest | |
---|---|---|---|---|
Abl: transcatheter ablation; ADT: antiarrhythmic drug treatment; AF: atrial fibrillation. | ||||
Abl without ADT | 3 | - | - | 1 |
Abl with ADT | 4 | - | - | 2 |
Rate control strategy | 2 | 1 | 1 | - |
Rhythm control strategy | 4 | 3 | 1 | 3 |