Cardiac electrophysiology review
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Card Electrophysiol Rev · Jun 2003
Review Randomized Controlled Trial Clinical TrialConfounding factors in rate versus rhythm control trials in patients with atrial fibrillation: lessons from the strategies of treatment of atrial fibrillation (STAF) pilot study.
The Strategies of Treatment of Atrial Fibrillation (STAF) multicenter pilot trial was one of five completed clinical studies to compare two treatment strategies in patients with atrial fibrillation: the strategy of rhythm control (restoration and maintenance of sinus rhythm) and the strategy of rate control (pharmacologic or invasive rate control and anticoagulation). ⋯ The STAF pilot trial did not show any differences between the two treatment strategies in common with other trials of rhythm versus rate control. These data suggest that there is no benefit in attempting rhythm control in this group of patients with a high risk of arrhythmia recurrence. It remains unclear whether the results in the group of rhythm control would have been better if sinus rhythm had been maintained in a higher proportion of patients since all but one endpoint occurred during atrial fibrillation.
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Card Electrophysiol Rev · Jun 2003
Review Randomized Controlled Trial Clinical TrialThe RACE study in perspective of randomized studies on management of persistent atrial fibrillation.
Atrial fibrillation is the most common sustained cardiac arrhythmia. Treatment strategies are focused on reducing symptoms and minimizing the risks of atrial fibrillation like stroke and heart failure. First choice therapy is the rhythm control strategy, with restoration of sinus rhythm. ⋯ It was observed from RACE that 21 of the 35 thromboembolic complications occurred under rhythm control, the majority while receiving inadequate anticoagulation therapy. Also in AFFIRM, with patients with one or more stroke risk factors, more strokes were present under rhythm control. Therefore, one of the main lesson learned from the randomized studies is that anticoagulation must be continued if stroke risk factors are present even if patients maintain sinus rhythm.
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Card Electrophysiol Rev · Jun 2003
ReviewAtrial fibrillation after cardiac surgery: update on the evidence on the available prophylactic interventions.
Post-operative atrial fibrillation is very common. It is associated with increased length of ICU and hospital stay, and costs of post-operative care of patients after cardiac surgery. ⋯ Meta-analysis of these trials, together with detailed analysis of the largest of these trials suggested that conventional beta-blockers, sotalol, amiodarone and bi-atrial overdrive pacing are effective in prevention of post-operative atrial fibrillation. Amiodarone and bi-atrial pacing may decrease the length of hospital stay.
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Card Electrophysiol Rev · Jun 2003
Randomized Controlled Trial Comparative Study Clinical TrialRate-control versus conversion strategy in postoperative atrial fibrillation: trial design and pilot study results.
Atrial fibrillation (AF) remains a frequent complication of cardiac surgery. The optimal treatment strategy has not been established. Retrospective studies have suggested that a primary rate-control strategy may be equivalent to a strategy that restores sinus rhythm. ⋯ In conclusion, this pilot study shows little difference between a rate-control strategy and a strategy to restore/maintain sinus rhythm. Regardless of the strategy, majority of patients will be in sinus rhythm after two months. A larger randomized, controlled study is needed to assess the impact of restoration of sinus rhythm on length of stay.
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Card Electrophysiol Rev · Jun 2003
Review Randomized Controlled Trial Clinical TrialIntravenous versus oral beta-blockers for prevention of post-CABG atrial fibrillation in high-risk patients identified by signal-averaged ECG: lessons of a pilot study.
Atrial fibrillation (AF) is the most common complication of coronary artery bypass grafting (CABG), usually occurring on the second or third post-operative day. Post-operative AF is associated with prolonged hospital stay and increased costs. In several randomized trials, prophylactic oral beta-blocker reduced the incidence of post-operative AF. ⋯ In the esmolol group, 11 (41%) patients developed adverse effects, mostly hypotension, compared to only one patient (4%) in the oral beta-blocker group (p = 0.006). The result of this pilot study showed that intravenous esmolol compared to oral beta-blocker offers no advantage in preventing post-operative AF and is associated with increased adverse events. Thus, all patients without contraindication should receive oral beta-blocker before and after cardiac surgery to prevent post-operative AF.