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Rhythm control without catheter ablation may have benefits beyond stroke prevention in rivaroxaban-treated non-permanent atrial fibrillation

The current treatment paradigm for atrial fibrillation (AF) prioritizes rate control over rhythm control; however, rhythm control has shown benefits over other AF strategies. This study compares the outcomes of rivaroxaban with and without concomitant antiarrhythmic drugs (AADs), using propensity sc...

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Autores principales: Chiou, Wei-Ru, Lin, Po-Lin, Huang, Chun-Che, Chuang, Jen-Yu, Liu, Lawrence Yu-Min, Su, Min-I, Liao, Feng-Ching, Kuo, Jen-Yuan, Tsai, Cheng-Ting, Wu, Yih-Jer, Wang, Kuang-Te, Lee, Ying-Hsiang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8904581/
https://www.ncbi.nlm.nih.gov/pubmed/35260615
http://dx.doi.org/10.1038/s41598-022-07466-z
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author Chiou, Wei-Ru
Lin, Po-Lin
Huang, Chun-Che
Chuang, Jen-Yu
Liu, Lawrence Yu-Min
Su, Min-I
Liao, Feng-Ching
Kuo, Jen-Yuan
Tsai, Cheng-Ting
Wu, Yih-Jer
Wang, Kuang-Te
Lee, Ying-Hsiang
author_facet Chiou, Wei-Ru
Lin, Po-Lin
Huang, Chun-Che
Chuang, Jen-Yu
Liu, Lawrence Yu-Min
Su, Min-I
Liao, Feng-Ching
Kuo, Jen-Yuan
Tsai, Cheng-Ting
Wu, Yih-Jer
Wang, Kuang-Te
Lee, Ying-Hsiang
author_sort Chiou, Wei-Ru
collection PubMed
description The current treatment paradigm for atrial fibrillation (AF) prioritizes rate control over rhythm control; however, rhythm control has shown benefits over other AF strategies. This study compares the outcomes of rivaroxaban with and without concomitant antiarrhythmic drugs (AADs), using propensity score matching to correct for statistical effects of baseline discrepancies. This multi-center retrospective study included 1,477 patients with non-permanent AF who took rivaroxaban for at least one month between 2011 and 2016 and had not received catheter ablation. Concomitant AAD use was compared against clinical outcome endpoints for effectiveness, safety, and major adverse cardiac events (MACE). Associations with concomitant AAD use were evaluated using multivariate Cox proportional hazard analyses. Patients were divided into two matched groups: rivaroxaban alone (n = 739) and with concomitant AADs (n = 738). The cumulative incidences of safety (p = 0.308), effectiveness (p = 0.583), and MACE (p = 0.754) were similar between the two groups, and multivariate analysis showed no significant differences. The new thromboembolism and all-cause death rates were higher in rivaroxaban alone (2.7% vs 0.8%, p = 0.005; and 10% vs. 6.9%, p = 0.032, respectively). The heart failure readmission rate was higher in the concomitant-AAD group (8.4% vs. 13.3%, p = 0.003). The concomitant use of rivaroxaban with AADs appears to be well-tolerated, with lower rates of thromboembolism and all-cause death, but is associated with more occurrences of congestive heart failure.
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spelling pubmed-89045812022-03-09 Rhythm control without catheter ablation may have benefits beyond stroke prevention in rivaroxaban-treated non-permanent atrial fibrillation Chiou, Wei-Ru Lin, Po-Lin Huang, Chun-Che Chuang, Jen-Yu Liu, Lawrence Yu-Min Su, Min-I Liao, Feng-Ching Kuo, Jen-Yuan Tsai, Cheng-Ting Wu, Yih-Jer Wang, Kuang-Te Lee, Ying-Hsiang Sci Rep Article The current treatment paradigm for atrial fibrillation (AF) prioritizes rate control over rhythm control; however, rhythm control has shown benefits over other AF strategies. This study compares the outcomes of rivaroxaban with and without concomitant antiarrhythmic drugs (AADs), using propensity score matching to correct for statistical effects of baseline discrepancies. This multi-center retrospective study included 1,477 patients with non-permanent AF who took rivaroxaban for at least one month between 2011 and 2016 and had not received catheter ablation. Concomitant AAD use was compared against clinical outcome endpoints for effectiveness, safety, and major adverse cardiac events (MACE). Associations with concomitant AAD use were evaluated using multivariate Cox proportional hazard analyses. Patients were divided into two matched groups: rivaroxaban alone (n = 739) and with concomitant AADs (n = 738). The cumulative incidences of safety (p = 0.308), effectiveness (p = 0.583), and MACE (p = 0.754) were similar between the two groups, and multivariate analysis showed no significant differences. The new thromboembolism and all-cause death rates were higher in rivaroxaban alone (2.7% vs 0.8%, p = 0.005; and 10% vs. 6.9%, p = 0.032, respectively). The heart failure readmission rate was higher in the concomitant-AAD group (8.4% vs. 13.3%, p = 0.003). The concomitant use of rivaroxaban with AADs appears to be well-tolerated, with lower rates of thromboembolism and all-cause death, but is associated with more occurrences of congestive heart failure. Nature Publishing Group UK 2022-03-08 /pmc/articles/PMC8904581/ /pubmed/35260615 http://dx.doi.org/10.1038/s41598-022-07466-z Text en © The Author(s) 2022, corrected publication 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Chiou, Wei-Ru
Lin, Po-Lin
Huang, Chun-Che
Chuang, Jen-Yu
Liu, Lawrence Yu-Min
Su, Min-I
Liao, Feng-Ching
Kuo, Jen-Yuan
Tsai, Cheng-Ting
Wu, Yih-Jer
Wang, Kuang-Te
Lee, Ying-Hsiang
Rhythm control without catheter ablation may have benefits beyond stroke prevention in rivaroxaban-treated non-permanent atrial fibrillation
title Rhythm control without catheter ablation may have benefits beyond stroke prevention in rivaroxaban-treated non-permanent atrial fibrillation
title_full Rhythm control without catheter ablation may have benefits beyond stroke prevention in rivaroxaban-treated non-permanent atrial fibrillation
title_fullStr Rhythm control without catheter ablation may have benefits beyond stroke prevention in rivaroxaban-treated non-permanent atrial fibrillation
title_full_unstemmed Rhythm control without catheter ablation may have benefits beyond stroke prevention in rivaroxaban-treated non-permanent atrial fibrillation
title_short Rhythm control without catheter ablation may have benefits beyond stroke prevention in rivaroxaban-treated non-permanent atrial fibrillation
title_sort rhythm control without catheter ablation may have benefits beyond stroke prevention in rivaroxaban-treated non-permanent atrial fibrillation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8904581/
https://www.ncbi.nlm.nih.gov/pubmed/35260615
http://dx.doi.org/10.1038/s41598-022-07466-z
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