Abstract
Camm et al (J Am Coll Cardiol 2011;58:493–501, PMID 21777747) reported on the first worldwide, prospective, observational survey of management of atrial fibrillation (AF) in unselected, community-based patients (RECORDAF). Primary outcomes were therapeutic success and clinical outcomes associated with rhythm-control and rate-control strategies. Therapeutic success required that strategy was unchanged without clinical events. Maintenance of sinus rhythm was required in the rhythm-control group and heart rate ≤80 bpm in the rate-control group. In 5171 patients, the success was 54% overall (rhythm control 60% vs rate control 47%). The rhythm-control strategy was significantly related to superior therapeutic success (hazard ratio [HR] 1.34, P = .0002). The type of AF, presence of AF at baseline visit, and duration (>3 months) of AF, together with age older than 75 years and the presence of heart failure, predicted progression to permanent AF. The choice of rhythm control reduced the likelihood of AF progression (HR 0.20, P <.0001). The authors conclude that clinical outcomes in AF patients were driven mainly by hospitalizations for arrhythmia and proarrhythmia and other cardiovascular causes, but not by the choice of rate or rhythm strategy. Rhythm-control patients progressed less rapidly to permanent AF.
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