Rhythm control strategy in the transcatheter ablation era

Riccardo Maddalena 1 *
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1 Cardiology Unit, Fabrizio Spaziani Hospital, Frosinone, Italy.
* Corresponding Author
J CLIN MED KAZ, Volume 18, Issue 4, pp. 12-15. https://doi.org/10.23950/jcmk/11044
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ABSTRACT

The latest ESC guidelines on atrial fibrillation limit rhythm control to symptomatic cases, continuing on the same line that the Affirm and Race trials traced twenty years ago. There is evidence though that rhythm control, net of the adverse effects of the antiarrhythmic drugs, is useful to improve the prognosis beyond just the reduction of symptoms. With transcatheter ablation we can now finally split the clinical benefit of an antiarrhythmic therapy from the negative impact on prognosis of the medical approach, especially in patients with structural heart disease. We must ask ourselves nowadays, in light of the latest trials analyzed in this review, if there is space for a first line rhythm control strategy, if it should be pursued regardless of symptoms, with what modalities and how much in particular the patient with reduced ejection fraction can benefit from it.

CITATION

Maddalena R. Rhythm control strategy in the transcatheter ablation era. J CLIN MED KAZ. 2021;18(4):12-5. https://doi.org/10.23950/jcmk/11044

REFERENCES

  • Debra S. Echt, Philip R. Liebson, Brent Mitchell, Robert W. Peters, Dulce Obias-Manno, Allan H. Barker et al. Mortality and Morbidity in Patients Receiving Encainide, Flecainide, or Placebo – The Cardiac Arrhythmia Suppression Trial. N Eng J Med. 1991; 324:781-788. DOI: 10.1056/NEJM199103213241201
  • Albert L Waldo, A J Camm, H deRuyter, P L Friedman, D J MacNeil, J F Paulus et al. Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The Lancet. 1996; 348:7-12. DOI:https://doi.org/10.1016/S0140-6736(96)02149-6
  • Lars Køber, Christian Torp-Pedersen, John J V McMurray, Ole Gøtzsche,Samuel Lévy, Harry Crijns et al. Increased Mortality after Dronedarone Therapy for Severe Heart Failure. N Eng J Med. 2008; 358:2678-2687. DOI: 10.1056/NEJMoa0800456
  • Stuart J. Connolly, A. John Camm, Jonathan L. Halperin, Campbell Joyner, Marco Aligns, John Amerena et al. Dronedarone in High-Risk Permanent Atrial Fibrillation. N Eng J Med. 2011; 365:2268-2276. DOI: 10.1056/NEJMoa1109867
  • Lucie Valembois, Etienne Audureau, Andrea Takeda, Witold Jarzebowski, Joel Belmin, Carmelo Lafuente-Lafuente. Antiarrhythmics for maintaining sinus thythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev. 2019. doi: 10.1002/14651858.CD005049.pub5
  • The AFFIRM Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Eng J Med. 2002; 347:1825-1833. DOI: 10.1056/NEJMoa021328
  • Isabelle C Van Gelder, Vincent E Hagens, Hans A Bosker, J Herre Kingma, Otto Kamp, Tsjerk Kingma et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Eng J Med. 2002; 347:1834-40. DOI: 10.1056/NEJMoa021328
  • Denis Roy, Mario Talajic, Stanley Nattel, George Wyse, Paul Dorian, Kerry L. Lee et al. Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure. N Eng J Med. 2008; 358:2667-2677. DOI: 10.1056/NEJMoa0708789
  • David G Jones, Shouvik K Haldar, Wajid Hussain, Rakesh Sharma, Darrel P Francis, Shelley L Rahman-Haley et al. A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. J Am Coll Cardiol. 2013; 61:1894-1903. DOI: 10.1016/j.jacc.2013.01.069. Epub 2013 Mar 7
  • Ross J Hunter, Thomas J Berriman, Ihab Diab, Ravindu Kamdar, Laura Richmond, Victoria Baker et al. A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial). Circ Arrhythm Electrophysiol. 2014; 7:31-38. DOI: 10.1161/CIRCEP.113.000806. Epub 2014 Jan 1
  • Luigi Di Biase, Prasant Mohanty, Sanghamitra Mohanty, Pasquale Santangeli, Chintan Trivedi, Dhanunjaya Lakkireddy et al. Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial. Circulation. 2016; 133:1637-44. DOI: 10.1161/ CIRCULATIONAHA.115.019406. Epub 2016 Mar 30
  • Jens Cosedis Nielsen, Arne Johannessen, Pekka Raatikainen, Gerhard Hindricks, Hakan Walfridsson, Ole Kongstad et al. Radiofrequency Ablation as Initial Therapy in Paroxysmal Atrial Fibrillation. N Eng J Med. 2012; 367:1587-1595. DOI: 10.1056/NEJMoa1113566
  • Nassir F. Marrouche, Johannes Brachmann, Dietrich Andresen, Jurgen Siebels, Lucas Boersma, Luc Jordaens et al. Catheter Ablation or Atrial Fibrillation with Heart Failure. N Eng J Med. 2018; 378:417-427. DOI: 10.1056/NEJMoa1707855
  • Karl-Heinz Kuck, Bela Merkely, Ralf Zahn, Thomas Arentz, Karlheinz Seidl, Michael Schluter et al. Catheter Ablation Versus Best Medical Therapy in Patients With Persistent Atrial Fibrillation and Congestive Heart Failure: The Randomized AMICA Trial. Circ Arrhythm Electrophysiol. 2019; 12. DOI: 10.1161/CIRCEP.119.007731. Epub 2019 Nov 25
  • Sandeep Prabhu, Andrew J Taylor, Ben T Costello, David M Kaye, Alex J A McLellan, Aleksandr Voskoboinik et al. Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction: The CAMERA-MRI Study. J Am Coll Cardiol. 2017; 70:1949-1961. DOI: 10.1016/j.jacc.2017.08.041. Epub 2017 Aug 27
  • Rhythm Control – Catheter Ablation With or Without Antiarrhythmic Drug Control of Maintaining Sinus Rhythm Versus Rate Control With Medical Therapy and/or Atrio-ventricular Junction Ablation and Pacemaker Treatment for Atrial Fibrillation (RAFT-AF). ClinicalTrials.gov NCT01420393
  • Ablation of Atrial Fibrillation in Heart Failure Patients (CONTRA-HF). ClinicalTrials.gov NCT03062241
  • Douglas L. Packer, Daniel B. Mark, Richard A. Robb, Kristi H. Monahan, Tristram D. Bahnson, Jeanne E. Poole et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation -The CABANA Randomized Cliical Trial. JAMA. 2019; 321:1261-1274. DOI: 10.1001/jama.2019.0693
  • Paulus Kirchhof, A. John Camm, Andreas Goette, Axel Brandes, Lars Eckardt, Arif Elvan et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Eng J Med. 2020; 383:1305-1316. DOI: 10.1056/NEJMoa2019422. Epub 2020 Aug 29
  • Stefan H. Hohnloser, Harry J.G.M. Crijns, Martin van Eickels, Christophe Gaudin, Richard L. Page, Christian Torp.Pedersen et al. Effect of Dronedarone on Cardiovascular Events in Atrial Fibrillation. N Eng J Med. 2009; 360:668-78. DOI: 10.1056/NEJMoa0803778