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

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 sup...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898884/
https://www.ncbi.nlm.nih.gov/pubmed/31755940
http://dx.doi.org/10.1093/eurheartj/ehz782
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author 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
author_facet 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
author_sort Willems, Stephan
collection PubMed
description 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.
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spelling pubmed-68988842019-12-12 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 Eur Heart J Clinical Review 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. Oxford University Press 2019-12-07 2019-11-22 /pmc/articles/PMC6898884/ /pubmed/31755940 http://dx.doi.org/10.1093/eurheartj/ehz782 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Review
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
title Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation
title_full Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation
title_fullStr Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation
title_full_unstemmed Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation
title_short Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation
title_sort cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation
topic Clinical Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898884/
https://www.ncbi.nlm.nih.gov/pubmed/31755940
http://dx.doi.org/10.1093/eurheartj/ehz782
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