Cardioversion differences among first detected episode, paroxysmal, and persistent atrial fibrillation patients in the RHYTHM AF registry in Poland

Background: The aim of the publication is to show differences among patients with the first detected episode of atrial fibrillation (AF), paroxysmal, and persistent AF patients, for whom cardioversion was planned in the hospital setting in Poland. Methods: We present an analysis of the Polish cohort of the multicenter, multinational RHYTHM-AF registry. Consecutive patients in the hospital setting, aged ≥ 18 years, with documented AF at the time of enrollment, and for whom cardioversion of AF is one of the planned therapeutic options were recruited. Follow-up data was collected 60 days after enrollment. Results: Five-hundred-and-one patients were recruited, 483 with a defined AF type: 88 — first detected, 191 paroxysmal, and 204 persistent AF. CHA2DS2VASc scores were not significantly different between the groups, while treatment with vitamin K antagonists (VKA) was significantly lower in paroxysmal AF group than in persistent AF patients. Primary electrical cardioversion was most commonly performed in patients with persistent AF (90.4%), while primary pharmacological cardioversion — in the first detected AF (80.0%) and paroxysmal AF patients (76.7%). During 2 months of follow-up, the rate of rehospitalization and complications was comparable among the groups. Conclusions: Despite their comparable CHA2DS2VASc scores, patients with persistent AF were more frequently treated with VKA antagonists than other groups. Recurrence of AF within 2 months after restoring sinus rhythm was present in about 25% of the patients, and the rate of complications was not different among the three groups.

Cardioversion of Atrial Fibrillation (RHYTHM-AF) International Registry in Poland

Background: A key procedure of the rhythm control strategy in atrial fibrillation (AF) is cardioversion to normal sinus rhythm. The aim of the present study was to provide a review of treatment patterns for the cardioversion of patients with AF in a hospital setting in Poland and document the success rate of various cardioversion procedures.Methods: We herein present the results from Poland of a prospective observational study to characterize patients with recent onset episodes of AF for whom cardioversion is one of the planned therapeutic options — the RHYTHM-AF registry. Consecutive patients in the hospital setting, age > 18 years, with documented AF at the time of enrollment, excluding those with atrial flutter and those treated with vernakalant, were recruited. No treatment was recommended nor discouraged.Results: Five hundred and one patients were recruited (mean age 64.2 ± 12.1), with 294 (58.7%) patients finally undergoing cardioversion. Primary electrical cardioversion (ECV) was successful in 131 (88.5%) patients. Primary pharmacological cardioversion (PCV) was successful in 110 (75.3%) patients. Amiodarone and propafenone were most commonly used (52.1% and 24.7%, respectively). Fourteen complications and adverse events were recorded (no stroke was observed).Conclusions: Conversion to sinus rhythm was attempted in < 60% of the patients with AF admitted to the hospital with an intention to terminate arrhythmia. ECV was successful in ~90% of the patients, while PCV in ~75% of the patients (amiodarone and propafenone were most commonly used). The rate of complications was low (2.8%).

Sinus rhythm restoration and risk of stroke in patients with persistent atrial fibrillation

Wstęp. Leczenie przeciwzakrzepowe zmniejsza częstość udarów niedokrwiennych centralnego układu nerwowego (CUN) u chorych z przetrwałym migotaniem przedsionków (AF, atrial fibrillation). Nie wiadomo jednak, czy przywrócenie i utrzymanie rytmu zatokowego w tej grupie pacjentów pozwala zmniejszyć częstość udarów. Celem pracy była ocena wpływu przywrócenia rytmu zatokowego na częstość udarów niedokrwiennych CUN u chorych z przetrwałym AF. Materiał i metody. Badano grupę 205 pacjentów (K/M 71/134; śr. wieku 60,8 ± 11,2 roku) z przetrwałym AF, w wieku 50–75 lat, zakwalifikowanych do programu How To Treat Chronic Atrial Fibrillation (HOT CAFE), w którym porównywano w sposób prospektywny i randomizowany odległe efekty dwóch strategii terapeutycznych: kontroli częstości rytmu komór u chorych, u których pozostawiono AF i jednocześnie długotrwale stosowano leczenie przeciwzakrzepowe (grupa I) lub przywrócenia i utrzymania SN (grupa II). W obu grupach oceniano częstość udarów CUN. Dopuszczalna etiologia AF wiązała się z chorobą niedokrwienną serca, nadciśnieniem tętniczym, nieistotną hemodynamicznie wadą zastawkową serca (z wyłączeniem stenozy mitralnej). Zdarzało się również, że nie miała uchwytnej przyczyny (idiopatyczne AF). Średni czas obserwacji wynosił co najmniej 12 miesięcy. Wyniki. W grupie I 101 pacjentów (K/M 38/63; śr. wieku 61,4 ± 17,6 roku) poddano profilaktyce przeciwzakrzepowej zgodnie z obowiązującymi standardami. W grupie II u 104 chorych (K/M 33/71; śr. wieku 60,4 ± 7,9 roku) wykonano planową kardiowersję elektryczną po wcześniejszym stosowaniu doustnych antykoagulantów przez 3 tygodnie i przez co najmniej 4 tygodnie po przywróceniu rytmu zatokowego. Skuteczność tego zabiegu wynosiła 86,3%, a po roku rytm ten utrzymywał się u 63,5% chorych. W czasie badania obserwowano 3 udary niedokrwienne CUN, przy czym wszystkie wystąpiły w grupie pacjentów zakwalifikowanych do przywrócenia rytmu zatokowego; dwa z nich (1,9%) wystąpiły w 3. dobie po zabiegu kardiowersji, 1 (0,9%) wiązał się z późnym nawrotem AF. Wnioski. Próba przywrócenia i utrzymania rytmu zatokowego nie zmniejsza ryzyka udarów CUN u chorych z przetrwałym AF w porównaniu do chorych, u których pozostawiono AF i jednocześnie stosowano profilaktyczne leczenie przeciwzakrzepowe.Background. The efficacy of oral anticoagulation in primary stroke prevention in pts with atrial fibrillation (AF) is well recognized. It is still unknown whether the strategy of cardioversion (CV) and efforts to maintain sinus rhythm (SR) in pts with persistent AF reduce effectively thromboembolic complications. Aim of the study was to assess impact of SR restoration on relative risk of systemic embolization episodes frequency in pts with persistent AF. Material and methods. How To Treat Patients With Chronic Atrial Fibrillation (HOT CAFE Polish Study) was designed to evaluate in randomized, multicenter and prospective manner risks and advantages of two therapeutical strategies in patients (pts) with chronic atrial fibrillation (CAF): rate control vs. rhythm control. Inclusion criteria were: pts age 50-75 years, CAF lasting from 7 days up to 2 years with etiology of arrhythmia related to hypertension, ischemic heart disease and hemodynamic insignificant valvular heart disease or lack of assessable etiology (idiopathic AF). Our study population comparised 205 pts (F/M 71/134; mean age 60.8 ± 11.2 year). Observation period was 12 months. Results. 104 pts (F/M 33/71; mean age 60.4 ± 7.9) were randomly assigned to rhythm control (group II). At the end of follow-up, 63.5% of pts remained in SR. Anticoagulation therapy was considered in all 101 pts (F/M 38/63; mean age 61.4 ± 17.6) assigned to the rate control group (group I) and there were no thromboembolic complications observed. Three pts suffered ischemic strokes in the rhythm control arm (NS). Two of them (1.9%), both resulting in death, were observed on the third day following successful CV. The third stroke (0.9%) which was not disabling, affected a patient with AF recurrence. Conclusions. The strategy of SR restoration and maintenance in pts with persistent AF does not reduce the risk of thromboembolic complications