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Atrial Fibrillation Rate Control

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2. Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall-Related Injuries and Syncope

Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall-Related Injuries and Syncope Management of atrial fibrillation (AF) with rate and/or rhythm control could lead to fall-related injuries and syncope, especially in the older AF population. We aimed to determine the association of rate and/or rhythm control with fall-related injuries and syncope in a real-world older AF cohort.A retrospective cohort study.Danish nationwide administrative registries from 2000 to 2015 (...) .A total of 100 935 patients with AF aged 65 years or older claiming prescription of rate-lowering drugs (RLDs) and/or anti-arrhythmic drugs (AADs) were included. We compared the use of rate-lowering monotherapy with rate-lowering dual therapy, AAD monotherapy, and AAD combined with rate-lowering therapy.Outcomes were fall-related injuries and syncope as a composite end point (primary) or separate end point (secondary).In this population, the median age was 78 years (interquartile range [IQR] = 72-84 y

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2019 EvidenceUpdates

3. Cohort study: Still many unanswered questions about rate control therapy in atrial fibrillation

Cohort study: Still many unanswered questions about rate control therapy in atrial fibrillation Still many unanswered questions about rate control therapy in atrial fibrillation | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log in using your username and password For personal accounts OR managers (...) of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Still many unanswered questions about rate control therapy in atrial fibrillation Article Text Therapeutics/Prevention Cohort study Still many unanswered questions about rate control therapy in atrial fibrillation

2016 Evidence-Based Medicine (Requires free registration)

4. Is Rhythm Control Better Than Rate Control for New-Onset Atrial Fibrillation in the Emergency Department?

Is Rhythm Control Better Than Rate Control for New-Onset Atrial Fibrillation in the Emergency Department? Systematic Review Snapshot TAKE-HOME MESSAGE In patients with new-onset atrial ?brillation and symptom onset within 48 hours, rhythm control is preferred over rate control if the patient is younger than 65 years. For patients with congestive heart failure, valvular heart disease, hypertension, or permanent atrial ?brillation, rate control remains the favored strategy. Is Rhythm Control (...) Better Than Rate Control for New-Onset Atrial Fibrillation in the Emergency Department? EBEM Commentators Rohith R. Malya, MD, MSc Department of Emergency Medicine University of Texas at Houston Houston, TX Latha Ganti, MD, MS Department of Emergency Medicine University of Central Florida Gainesville, FL North Florida-South Georgia Veterans Affairs Medical Center Lake City, FL Results ED-relevant atrial ?brillation trials. Study (n) Design Inclusion Criteria Primary Outcome Results PIAF, 2 2000 (252

2015 Annals of Emergency Medicine Systematic Review Snapshots

5. Rate versus rhythm control for treatment of postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of randomized controlled trials

Rate versus rhythm control for treatment of postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of randomized controlled trials Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability (...) , editorial) 2. Not an in vivo animal study 3. No metastases/ only primary tumor 4. No control group 5. Combination therapy or contamination 6. Not about analgesics used in the clinic Full text-screening: As above, with the addition of: 7. No relevant outcome measure reported ">Prioritise the exclusion criteria Example: Two reviewers will independently extract data from each article. We first try to extract numerical data from tables, text or figures. If these are not reported, we will extract data from

2019 PROSPERO

6. Impact of treatment crossovers on clinical outcomes in the rate and rhythm control strategies for atrial fibrillation: Insights from the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. (PubMed)

Impact of treatment crossovers on clinical outcomes in the rate and rhythm control strategies for atrial fibrillation: Insights from the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial. We investigated the rates and reasons for crossover to alternative treatment strategies and its impact on mortality in patients who were enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial. Over a mean follow-up period of 3.5 years, 842 (...) failure to control atrial fibrillation symptoms (159/248, 64.1%) and intolerable adverse effects (9/248, 3.6%). This difference in crossover pattern was statistically significant (P < 0.0001). There was a significantly decreased risk of all-cause mortality (adjusted HR: 0.61, 95% CI: 0.48-0.78, P < 0.0001) and cardiac mortality (adjusted hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.43-0.88, P = 0.008) in the subgroup of patients who crossed over from rhythm to rate control as compared

2018 Pacing and clinical electrophysiology : PACE

7. Benefits of rhythm control and rate control in recent-onset atrial fibrillation. the hermes-af study. (PubMed)

Benefits of rhythm control and rate control in recent-onset atrial fibrillation. the hermes-af study. Although rhythm control has failed to demonstrate long-term benefits over rate control in longstanding episodes of atrial fibrillation (AF), there is little evidence concerning recent-onset ones. We analyzed the benefits of rhythm and rate control in terms of symptoms alleviation and need for hospital admission in patients with recent-onset AF.This was a multicenter, observational, cross (...) -sectional study with prospective standardized data collection carried out in 124 emergency departments (EDs). Clinical variables, treatment effectiveness, and outcomes (control of symptoms, final disposition) were analyzed in stable patients with recent-onset AF consulting for AF-related symptoms.Of 421 patients included, rhythm control was chosen in 352 patients (83.6%), a global effectiveness of 84%. Rate control was performed in 69 patients (16.4%) and was achieved in 67 (97%) of them. Control

2019 Academic Emergency Medicine

8. Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association

of stroke/systemic embolism. AF >24 h: HR=3.24 (95% CI, 1.51–6.95) AF indicates atrial fibrillation; AHRE, atrial high-rate episode; AT, atrial tachycardia; CI, confidence interval; CIEDs, cardiac implantable electronic devices; CRT, cardiac resynchronization therapy; EGM, electrogram; HR, hazard ratio; ICD, implantable cardioverter-defibrillator; OR, odds ratio; PPM, permanent pacemaker; RCT, randomized controlled trial; TE, thromboembolic; and TIA, transient ischemic attack. Conclusions In virtually (...) tachyarrhythmias , atrial high-rate episodes , subclinical atrial fibrillation , silent atrial fibrillation , and subclinical atrial tachyarrhythmias . The document was peer reviewed by official external reviewers representing experts in population-based, clinical, and translational research on AF. Definition of AF Burden In the simplest sense, AF burden refers to the amount of AF that an individual has. By considering AF burden, we regard AF as a quantitative entity and move beyond merely treating AF

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2018 American Heart Association

9. What is the most clinical and cost effective treatment strategy (rate or rhythm control or no treatment) for people with atrial fibrillation after cardiothoracic surgery?

What is the most clinical and cost effective treatment strategy (rate or rhythm control or no treatment) for people with atrial fibrillation after cardiothoracic surgery? Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability (...) , editorial) 2. Not an in vivo animal study 3. No metastases/ only primary tumor 4. No control group 5. Combination therapy or contamination 6. Not about analgesics used in the clinic Full text-screening: As above, with the addition of: 7. No relevant outcome measure reported ">Prioritise the exclusion criteria Example: Two reviewers will independently extract data from each article. We first try to extract numerical data from tables, text or figures. If these are not reported, we will extract data from

2019 PROSPERO

10. Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery

Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery Rotation Prep | NEJM Resident 360 Social Login Email Login Log in via Email Create Your Account We will not share your email with anyone. Password must be at least 8 characters. Show or Hide the password you are typing. Request to Join has invited you to join this group Your browser does not support video tags Welcome! NEJM Resident 360 helps you prepare for your next rotation quickly and efficiently, provides

2016 Now@NEJM

11. Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction: The CAMERA-MRI Study

Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction: The CAMERA-MRI Study Atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD) frequently co-exist despite adequate rate control. Existing randomized studies of AF and LVSD of varying etiologies have reported modest benefits with a rhythm control strategy.The goal of this study was to determine whether catheter ablation (CA) for AF could improve LVSD compared with medical rate control (...) improvements in ventricular function, particularly in the absence of ventricular fibrosis on CMR. This outcome challenges the current treatment paradigm that rate control is the appropriate strategy in patients with AF and LVSD. (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction [CAMERA-MRI]; ACTRN12613000880741).Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

2017 EvidenceUpdates

12. Subcutaneous nerve stimulation for rate control in ambulatory dogs with persistent atrial fibrillation. (PubMed)

Subcutaneous nerve stimulation for rate control in ambulatory dogs with persistent atrial fibrillation. Subcutaneous nerve stimulation (ScNS) damages the stellate ganglion and improves rhythm control of atrial fibrillation (AF) in ambulatory dogs.The purpose of this study was to test the hypothesis that thoracic ScNS can improve rate control in persistent AF.We created persistent AF in 13 dogs and randomly assigned them to ScNS (n = 6) and sham control (n = 7) groups. 18F-2-Fluoro-2 (...) in the ScNS group than the sham control group at the end of the study.Thoracic ScNS causes neural remodeling in the brain stem and stellate ganglia, controls the ventricular rate, and preserves the left ventricular ejection fraction in ambulatory dogs with persistent AF.Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

2019 Heart Rhythm

13. Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall-Related Injuries and Syncope. (PubMed)

Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall-Related Injuries and Syncope. Management of atrial fibrillation (AF) with rate and/or rhythm control could lead to fall-related injuries and syncope, especially in the older AF population. We aimed to determine the association of rate and/or rhythm control with fall-related injuries and syncope in a real-world older AF cohort.A retrospective cohort study.Danish nationwide administrative registries from 2000 to 2015 (...) .A total of 100 935 patients with AF aged 65 years or older claiming prescription of rate-lowering drugs (RLDs) and/or anti-arrhythmic drugs (AADs) were included. We compared the use of rate-lowering monotherapy with rate-lowering dual therapy, AAD monotherapy, and AAD combined with rate-lowering therapy.Outcomes were fall-related injuries and syncope as a composite end point (primary) or separate end point (secondary).In this population, the median age was 78 years (interquartile range [IQR] = 72-84 y

2019 Journal of the American Geriatrics Society

14. The effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter: A systematic review with meta-analysis and Trial Sequential Analysis. (PubMed)

The effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter: A systematic review with meta-analysis and Trial Sequential Analysis. Atrial fibrillation and atrial flutter may be managed by either a rhythm control strategy or a rate control strategy but the evidence on the clinical effects of these two intervention strategies is unclear. Our objective was to assess the beneficial and harmful effects of rhythm control strategies versus rate (...) control strategies for atrial fibrillation and atrial flutter.We searched CENTRAL, MEDLINE, Embase, LILACS, Web of Science, BIOSIS, Google Scholar, clinicaltrials.gov, TRIP, EU-CTR, Chi-CTR, and ICTRP for eligible trials comparing any rhythm control strategy with any rate control strategy in patients with atrial fibrillation or atrial flutter published before November 2016. Our primary outcomes were all-cause mortality, serious adverse events, and quality of life. Our secondary outcomes were stroke

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2017 PloS one

15. The effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis. (PubMed)

The effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis. Atrial fibrillation is the most common arrhythmia of the heart with a prevalence of approximately 2% in the western world. Atrial flutter, another arrhythmia, occurs less often with an incidence of approximately 200,000 new patients per year in the USA. Patients with atrial fibrillation and atrial (...) flutter have an increased risk of death and morbidities. The management of atrial fibrillation and atrial flutter is often based on interventions aiming at either a rhythm control strategy or a rate control strategy. The evidence on the comparable effects of these strategies is unclear. This protocol for a systematic review aims at identifying the best overall treatment strategy for atrial fibrillation and atrial flutter.This protocol for a systematic review was performed following the recommendations

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2017 Systematic reviews

16. Can Multidetector Computed Tomography Rule Out Left Atrial Thrombus in Patients With Atrial Fibrillation? (SRS Diagnosis)

phase/ECG gate/pulse rate control (690) 0.99 (0.95–1.00) 0.99 (0.98–1.00) 60.8 (25.9–142.6) 0.03 (0.01–0.09) CI, Con?dence interval; LRþ, positive likelihood ratio; LR–, negative likelihood ratio. N¼number of patients included in the trial. METHODS DATA SOURCES PubMed and EMBASE were searched for prospective studies published before March 2014, using search terms to identify left atrial thrombus and multidetector CT. STUDY SELECTION Prospective human studies were included if they compared (...) admitted for rate control and scheduled for subsequent trans- esophageal echocardiogram to rule out left atrial thrombus before car- dioversion. Multidetector CT per- formedintheEDhasthepotentialto improve the safety of early cardio- version and, in some cases, obviate the need for admission for this population. The accuracy of multidetector CT for detecting left atrial thrombus compared with transesophageal echocardiogramisexcellent,with a 95.7% sensitivity and 91.7% speci?city. Using a combination

2018 Annals of Emergency Medicine Systematic Review Snapshots

17. Left atrial appendage occlusion (LAAO) in patients with atrial fibrillation who have contraindications to oral anticoagulation

ranged from 57% to 84% following LAAO (table 4). These estimates should be treated with some caution for the following reasons: ? The predicted ischaemic stroke rate was based on previously published studies – effectively a historical cohort – in patients that may have differed in baseline characteristics, underlying stroke risk, treatment or lifestyle factors. ? It is unclear whether the CHA 2DS 2-VASc score is accurate for predicting annual stroke risk in patients with atrial fibrillation (...) with atrial fibrillation and contraindications to oral anticoagulation were also extracted from the studies used in the clinical effectiveness section 5, 14, 15, 22-24, 26-28 (table 6). The primary study by Boersma et al (2017) 25 was not included in the safety section because it reported long-term outcomes from a study in the systematic review. In summary: ? The rate of peri-operative pericardial effusion with or without cardiac tamponade ranged from 0% to 7.5% of patients treated with LAAO. The highest

2019 SHTG Advice Statements

18. Rhythm control better prevents stroke and mortality than rate control strategies in patients with atrial fibrillation - A nationwide cohort study. (PubMed)

Rhythm control better prevents stroke and mortality than rate control strategies in patients with atrial fibrillation - A nationwide cohort study. Atrial fibrillation (AF) increases the risk of stroke and mortality. However, rhythm control strategy did not reduce cardiovascular risks in short-term studies. We hypothesize that rhythm control better prevents stroke and mortality than rate control in AF patients over a long-term period.AF patients aged ≥18 years were identified from Taiwan (...) National Insurance Database. Patients using anti-arrhythmia drugs to control rhythm at a >30 defined daily dose (DDD) were defined as the rhythm control group. Patients who used rate control medications for >30 DDDs constituted the rate control group. Multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for major adverse cardiovascular events (MACE), including ischemic/hemorrhagic stroke and mortality.A total of 11,968 AF patients were enrolled, and 2850 of them (654

2018 International journal of cardiology

19. Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study. (PubMed)

Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study. Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients.We performed an ancillary analysis from the 'Registro Politerapie SIMI' study, enrolling elderly inpatients from internal medicine and geriatric wards.We considered patients (...) enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy.Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short

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2018 Drugs & Aging

20. Rate Control or Rhythm Control for Atrial Fibrillation after Heart Surgery. (PubMed)

Rate Control or Rhythm Control for Atrial Fibrillation after Heart Surgery. 27557309 2016 08 26 2018 12 02 1533-4406 375 8 2016 08 25 The New England journal of medicine N. Engl. J. Med. Rate Control or Rhythm Control for Atrial Fibrillation after Heart Surgery. 801 10.1056/NEJMc1607939 Gillinov A Marc AM O'Gara Patrick T PT Mack Michael J MJ eng U01 HL088942 HL NHLBI NIH HHS United States Letter Comment United States N Engl J Med 0255562 0028-4793 0 Anti-Arrhythmia Agents N3RQ532IUT Amiodarone (...) AIM IM N Engl J Med. 2016 May 19;374(20):1911-21 27043047 N Engl J Med. 2016 Aug 25;375(8):799 27557310 N Engl J Med. 2016 Aug 25;375(8):800-1 27557313 N Engl J Med. 2016 Aug 25;375(8):799-800 27557311 N Engl J Med. 2016 Aug 25;375(8):800 27557312 Amiodarone therapeutic use Anti-Arrhythmia Agents therapeutic use Atrial Fibrillation drug therapy Cardiac Surgical Procedures Heart Rate drug effects Humans 2016 8 25 6 0 2016 8 25 6 0 2016 8 27 6 0 ppublish 27557309 10.1056/NEJMc1607939 10.1056

2016 NEJM

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