Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study.

Published on May 11, 2021in BMJ30.223
· DOI :10.1136/BMJ.N991
Daehoon Kim8
Estimated H-index: 8
(Yonsei University),
Pil Sung Yang20
Estimated H-index: 20
+ 8 AuthorsBoyoung Joung46
Estimated H-index: 46
(Yonsei University)
Abstract Objective To investigate whether the results of a rhythm control strategy differ according to the duration between diagnosis of atrial fibrillation and treatment initiation. Design Longitudinal observational cohort study. Setting Population based cohort from the Korean National Health Insurance Service database. Participants 22 635 adults with atrial fibrillation and cardiovascular conditions, newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control strategies between 28 July 2011 and 31 December 2015. Main outcome measure A composite outcome of death from cardiovascular causes, ischaemic stroke, admission to hospital for heart failure, or acute myocardial infarction. Results Of the study population, 12 200 (53.9%) were male, the median age was 70, and the median follow-up duration was 2.1 years. Among patients with early treatment for atrial fibrillation (initiated within one year since diagnosis), compared with rate control, rhythm control was associated with a lower risk of the primary composite outcome (weighted incidence rate per 100 person years 7.42 in rhythm control v 9.25 in rate control; hazard ratio 0.81, 95% confidence interval 0.71 to 0.93; P=0.002). No difference in the risk of the primary composite outcome was found between rhythm and rate control (weighted incidence rate per 100 person years 8.67 in rhythm control v 8.99 in rate control; 0.97, 0.78 to 1.20; P=0.76) in patients with late treatment for atrial fibrillation (initiated after one year since diagnosis). No significant differences in safety outcomes were found between the rhythm and rate control strategies across different treatment timings. Earlier initiation of treatment was linearly associated with more favourable cardiovascular outcomes for rhythm control compared with rate control. Conclusions Early initiation of rhythm control treatment was associated with a lower risk of adverse cardiovascular outcomes than rate control treatment in patients with recently diagnosed atrial fibrillation. This association was not found in patients who had had atrial fibrillation for more than one year.
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#2Tatjana S. PotparaH-Index: 37
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49 Citations
#1Daehoon Kim (Yonsei University)H-Index: 8
#2Pil Sung YangH-Index: 20
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#1Seng Chan You (Ajou University)H-Index: 7
#1Seng Chan You (Ajou University)H-Index: 13
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#1Paulus Kirchhof (UHH: University of Hamburg)H-Index: 108
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#1Daehoon Kim (Yonsei University)H-Index: 8
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Cited By0
#1M.N. Kim (Yonsei University)
#2Seng Chan You (Yonsei University)H-Index: 13
Last. Boyoung Joung (Yonsei University)H-Index: 46
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Abstract null Background null Catheter ablation is more effective than antiarrhythmic drug therapy alone in patients with atrial fibrillation (AF). However, there are limited data on the outcomes of AF ablation according to sex. The purpose of this study was to evaluate gender differences in the actual outcomes after catheter ablation for atrial fibrillation. null Methods null Of 801,710 patients with AF in the Korean National Health Insurance Service database, we identified 9175 patients withou...