Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation

Stephan Willems, Christian Meyer, Joseph de Bono, Axel Brandes, Lars Eckardt, Arif Elvan, Isabelle van Gelder, Andreas Goette, Michele Gulizia, Laurent Haegeli, Hein Heidbuchel, Karl Georg Haeusler, Josef Kautzner, Lluis Mont, G Andre Ng, Lukasz Szumowski, Sakis Themistoclakis, Karl Wegscheider, Paulus Kirchhof

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Resumé

Recent innovations have the potential to improve rhythm control therapy in patients with atrial fibrillation (AF). Controlled trials provide new evidence on the effectiveness and safety of rhythm control therapy, particularly in patients with AF and heart failure. This review summarizes evidence supporting the use of rhythm control therapy in patients with AF for different outcomes, discusses implications for indications, and highlights remaining clinical gaps in evidence. Rhythm control therapy improves symptoms and quality of life in patients with symptomatic AF and can be safely delivered in elderly patients with comorbidities (mean age 70 years, 3-7% complications at 1 year). Atrial fibrillation ablation maintains sinus rhythm more effectively than antiarrhythmic drug therapy, but recurrent AF remains common, highlighting the need for better patient selection (precision medicine). Antiarrhythmic drugs remain effective after AF ablation, underpinning the synergistic mechanisms of action of AF ablation and antiarrhythmic drugs. Atrial fibrillation ablation appears to improve left ventricular function in a subset of patients with AF and heart failure. Data on the prognostic effect of rhythm control therapy are heterogeneous without a clear signal for either benefit or harm. Rhythm control therapy has acceptable safety and improves quality of life in patients with symptomatic AF, including in elderly populations with stroke risk factors. There is a clinical need to better stratify patients for rhythm control therapy. Further studies are needed to determine whether rhythm control therapy, and particularly AF ablation, improves left ventricular function and reduces AF-related complications.

OriginalsprogEngelsk
TidsskriftEuropean Heart Journal
Vol/bind40
Udgave nummer46
Sider (fra-til)3793-3799c
ISSN0195-668X
DOI
StatusUdgivet - 7. dec. 2019

Fingeraftryk

Left Ventricular Function
Quality of Life
Safety
Precision Medicine
Patient Selection
Comorbidity
Population

Citer dette

Willems, Stephan ; Meyer, Christian ; de Bono, Joseph ; Brandes, Axel ; Eckardt, Lars ; Elvan, Arif ; van Gelder, Isabelle ; Goette, Andreas ; Gulizia, Michele ; Haegeli, Laurent ; Heidbuchel, Hein ; Haeusler, Karl Georg ; Kautzner, Josef ; Mont, Lluis ; Ng, G Andre ; Szumowski, Lukasz ; Themistoclakis, Sakis ; Wegscheider, Karl ; Kirchhof, Paulus. / Cabins, castles, and constant hearts : rhythm control therapy in patients with atrial fibrillation. I: European Heart Journal. 2019 ; Bind 40, Nr. 46. s. 3793-3799c.
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title = "Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation",
abstract = "Recent innovations have the potential to improve rhythm control therapy in patients with atrial fibrillation (AF). Controlled trials provide new evidence on the effectiveness and safety of rhythm control therapy, particularly in patients with AF and heart failure. This review summarizes evidence supporting the use of rhythm control therapy in patients with AF for different outcomes, discusses implications for indications, and highlights remaining clinical gaps in evidence. Rhythm control therapy improves symptoms and quality of life in patients with symptomatic AF and can be safely delivered in elderly patients with comorbidities (mean age 70 years, 3-7{\%} complications at 1 year). Atrial fibrillation ablation maintains sinus rhythm more effectively than antiarrhythmic drug therapy, but recurrent AF remains common, highlighting the need for better patient selection (precision medicine). Antiarrhythmic drugs remain effective after AF ablation, underpinning the synergistic mechanisms of action of AF ablation and antiarrhythmic drugs. Atrial fibrillation ablation appears to improve left ventricular function in a subset of patients with AF and heart failure. Data on the prognostic effect of rhythm control therapy are heterogeneous without a clear signal for either benefit or harm. Rhythm control therapy has acceptable safety and improves quality of life in patients with symptomatic AF, including in elderly populations with stroke risk factors. There is a clinical need to better stratify patients for rhythm control therapy. Further studies are needed to determine whether rhythm control therapy, and particularly AF ablation, improves left ventricular function and reduces AF-related complications.",
keywords = "AF ablation, Antiarrhythmic drugs, Atrial fibrillation, Heart failure, Mortality, Rhythm control therapy, Stroke",
author = "Stephan Willems and Christian Meyer and {de Bono}, Joseph and Axel Brandes and Lars Eckardt and Arif Elvan and {van Gelder}, Isabelle and Andreas Goette and Michele Gulizia and Laurent Haegeli and Hein Heidbuchel and Haeusler, {Karl Georg} and Josef Kautzner and Lluis Mont and Ng, {G Andre} and Lukasz Szumowski and Sakis Themistoclakis and Karl Wegscheider and Paulus Kirchhof",
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Willems, S, Meyer, C, de Bono, J, Brandes, A, Eckardt, L, Elvan, A, van Gelder, I, Goette, A, Gulizia, M, Haegeli, L, Heidbuchel, H, Haeusler, KG, Kautzner, J, Mont, L, Ng, GA, Szumowski, L, Themistoclakis, S, Wegscheider, K & Kirchhof, P 2019, 'Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation', European Heart Journal, bind 40, nr. 46, s. 3793-3799c. https://doi.org/10.1093/eurheartj/ehz782

Cabins, castles, and constant hearts : rhythm control therapy in patients with atrial fibrillation. / Willems, Stephan; Meyer, Christian; de Bono, Joseph; Brandes, Axel; Eckardt, Lars; Elvan, Arif; van Gelder, Isabelle; Goette, Andreas; Gulizia, Michele; Haegeli, Laurent; Heidbuchel, Hein; Haeusler, Karl Georg; Kautzner, Josef; Mont, Lluis; Ng, G Andre; Szumowski, Lukasz; Themistoclakis, Sakis; Wegscheider, Karl; Kirchhof, Paulus.

I: European Heart Journal, Bind 40, Nr. 46, 07.12.2019, s. 3793-3799c.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Cabins, castles, and constant hearts

T2 - rhythm control therapy in patients with atrial fibrillation

AU - Willems, Stephan

AU - Meyer, Christian

AU - de Bono, Joseph

AU - Brandes, Axel

AU - Eckardt, Lars

AU - Elvan, Arif

AU - van Gelder, Isabelle

AU - Goette, Andreas

AU - Gulizia, Michele

AU - Haegeli, Laurent

AU - Heidbuchel, Hein

AU - Haeusler, Karl Georg

AU - Kautzner, Josef

AU - Mont, Lluis

AU - Ng, G Andre

AU - Szumowski, Lukasz

AU - Themistoclakis, Sakis

AU - Wegscheider, Karl

AU - Kirchhof, Paulus

PY - 2019/12/7

Y1 - 2019/12/7

N2 - Recent innovations have the potential to improve rhythm control therapy in patients with atrial fibrillation (AF). Controlled trials provide new evidence on the effectiveness and safety of rhythm control therapy, particularly in patients with AF and heart failure. This review summarizes evidence supporting the use of rhythm control therapy in patients with AF for different outcomes, discusses implications for indications, and highlights remaining clinical gaps in evidence. Rhythm control therapy improves symptoms and quality of life in patients with symptomatic AF and can be safely delivered in elderly patients with comorbidities (mean age 70 years, 3-7% complications at 1 year). Atrial fibrillation ablation maintains sinus rhythm more effectively than antiarrhythmic drug therapy, but recurrent AF remains common, highlighting the need for better patient selection (precision medicine). Antiarrhythmic drugs remain effective after AF ablation, underpinning the synergistic mechanisms of action of AF ablation and antiarrhythmic drugs. Atrial fibrillation ablation appears to improve left ventricular function in a subset of patients with AF and heart failure. Data on the prognostic effect of rhythm control therapy are heterogeneous without a clear signal for either benefit or harm. Rhythm control therapy has acceptable safety and improves quality of life in patients with symptomatic AF, including in elderly populations with stroke risk factors. There is a clinical need to better stratify patients for rhythm control therapy. Further studies are needed to determine whether rhythm control therapy, and particularly AF ablation, improves left ventricular function and reduces AF-related complications.

AB - Recent innovations have the potential to improve rhythm control therapy in patients with atrial fibrillation (AF). Controlled trials provide new evidence on the effectiveness and safety of rhythm control therapy, particularly in patients with AF and heart failure. This review summarizes evidence supporting the use of rhythm control therapy in patients with AF for different outcomes, discusses implications for indications, and highlights remaining clinical gaps in evidence. Rhythm control therapy improves symptoms and quality of life in patients with symptomatic AF and can be safely delivered in elderly patients with comorbidities (mean age 70 years, 3-7% complications at 1 year). Atrial fibrillation ablation maintains sinus rhythm more effectively than antiarrhythmic drug therapy, but recurrent AF remains common, highlighting the need for better patient selection (precision medicine). Antiarrhythmic drugs remain effective after AF ablation, underpinning the synergistic mechanisms of action of AF ablation and antiarrhythmic drugs. Atrial fibrillation ablation appears to improve left ventricular function in a subset of patients with AF and heart failure. Data on the prognostic effect of rhythm control therapy are heterogeneous without a clear signal for either benefit or harm. Rhythm control therapy has acceptable safety and improves quality of life in patients with symptomatic AF, including in elderly populations with stroke risk factors. There is a clinical need to better stratify patients for rhythm control therapy. Further studies are needed to determine whether rhythm control therapy, and particularly AF ablation, improves left ventricular function and reduces AF-related complications.

KW - AF ablation

KW - Antiarrhythmic drugs

KW - Atrial fibrillation

KW - Heart failure

KW - Mortality

KW - Rhythm control therapy

KW - Stroke

U2 - 10.1093/eurheartj/ehz782

DO - 10.1093/eurheartj/ehz782

M3 - Journal article

C2 - 31755940

VL - 40

SP - 3793-3799c

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 46

ER -