Restoration of sinus rhythm in atrial fibrillation
Sübutlu məlumatların xülasələri
10.05.2016 • Sonuncu dəyişiklik 10.05.2016
Editors
Rhythm control by repeated cardioversion in elderly patients does not improve survival or quality of life compared to rate control. Sinus rhythm can be restored in about 80% of patients with atrial fibrillation and maintained in about 50% of patients receiving antiarrhytmic therapy.
A systematic review including 5 studies with a total of 5239 subjects was abstracted in DARE. There was no statistically significant difference in all-cause mortality between the rate and rhythm control groups (OR 0.87, 95% CI: 0.74 to 1.02, P=0.09) or stroke (3 RCTs, OR 0.50, 95% CI: 0.14 to 1.83, P=0.30).
In a multi-centre trial including 1376 patients with atrial fibrillation, symptoms of congestive heart failure and left ventricular ejection fraction of 35% or less, rhythm control was compared to rate control. Of these patients, 182 (27%) in the rhythm control group died from cardiovascular causes, as compared with 175 (25%) in the rate-control group (HR 1.06, 95% CI 0.86 to 1.30). In the rhythm control group 325 died of any cause, compared with 335 in the rate conrol group. The rates for stroke (3% vs 4%), worsening heart failure
(28% and 31%) were similar.
RACE and PIAF studies found no difference in quality of life with rhythm control compared with rate control.
A systematic review including 23 studies on intravenous agents (1,317 patients) and 24 studies on maintenance of sinus rhythm after cardioversion (2,000 patients), 6 trials for warfarin for prevention of thromboembolism, was abstracted in DARE. Cardioversion restores sinus rhythm in more than 80% of patients. In atrial fibrillation of recent onset, pharmacological therapy has a success rate of 40 - 90%. Maintenance of sinus rhythm at one year is maintained in about 50% of patients receiving antiarrhythmic therapy, but maintenance
occurs in only 30% of patients receiving no therapy. Successful cardioversion and maintenance are most effective when fibrillation is of brief duration.
The following decision support rules contain links to this evidence summary:
- Withholding repeated cardioversion in the elderly
Ədəbiyyat
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