The role of ascorbic acid in the prevention of atrial fibrillation after elective on-pump myocardial revascularization surgery: a single-center experience--a pilot study. Ascorbate Attenuates Atrial Pacing-Induced Peroxynitrite Formation and Electrical Remodeling and Decreases the Incidence of Postoperative Atrial Fibrillation Atrial fibrillation in patients with heart failure: Role of catheter ablation therapies. Cardiac rate normalization in chronic atrial fibrillation: comparison of long-term efficacy of treatment with amiodarone versus AV node ablation and permanent His-bundle pacing. Vernakalant Hydrochloride for the Rapid Conversion of Atrial Fibrillation After Cardiac Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial Statin therapy for the prevention of atrial fibrillation trial (SToP AF trial). Rationale and Design of FIRE AND ICE: A multicenter randomized trial comparing efficacy and safety of pulmonary vein isolation using a cryoballoon versus radiofrequency ablation with 3D-reconstruction. Fish intake and risk of incident atrial fibrillation. Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction: The TOPCAT Trial. Oral vitamin C administration reduces early recurrence rates after electrical cardioversion of persistent atrial fibrillation and attenuates associated inflammation. Palpitations are predictive of future atrial fibrillation. An 11-year follow-up of 22,815 men and women: the Tromsø Study Magnesium infusion and postoperative atrial fibrillation: a randomized clinical trial. C-reactive protein and atrial fibrillation: "evidence for the presence of inflammation in the perpetuation of the arrhythmia". The −174G/C Interleukin-6 Polymorphism Influences Postoperative Interleukin-6 Levels and Postoperative Atrial Fibrillation. Is Atrial Fibrillation an Inflammatory Complication? Comparison of rate and rhythm control in hypertension patients with atrial fibrillation. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study) Heat shock protein70: a new marker for subsequent atrial fibrillation development? Does left atrial appendage closure with a cardiac plug system reduce the stroke risk in nonvalvular atrial fibrillation patients? A single-center case series. A randomized clinical trial of early invasive intervention for atrial fibrillation (EARLY-AF) - methods and rationale. Atrial fibrillation: an observational study with outpatients. Perioperative supplementation with ascorbic acid does not prevent atrial fibrillation in coronary artery bypass graft patients. Efficacy of Dofetilide in the Treatment of Atrial Fibrillation-Flutter in Patients With Reduced Left Ventricular Function: A Danish Investigations of Arrhythmia and Mortality ON Dofetilide (DIAMOND) Substudy
Atrial fibrillation ( AF ) is a common arrhythmia that occurs postoperatively in cardiac surgery . There is evidence for the role of oxidative stress in the etiology of AF . In our study , we examined whether antioxidant ascorbic acid ( vitamin C ) , could help in the reduction of the incidence of postoperative AF . Patients who were scheduled to undergo elective isolated on-pump coronary artery bypass grafting ( CABG ) were included in our study . One hundred and seventy patients were r and omly divided in two groups : Group A ( n=85 ) received vitamin C preoperatively and postoperatively whereas Group B ( n=85 ) did not receive any ( control group ) . The incidence of AF was 44.7 % in the vitamin C group and 61.2 % in the control group ( P=0.041 ) . The hospitalization time , the intensive care unit stay and the time interval for the conversion of AF into sinus rhythm was significantly shorter in the vitamin C group . Patients that developed AF also had longer hospital length of stay ( 9.5±2.8 days vs. 6.7±1.9 , P=0.034 ) . Supplementation of vitamin C reduces the incidence of postCABG AF , and decreases the time needed for rhythm restoration and length of hospital stay Atrial fibrillation ( AF ) , the most common chronic arrhythmia , increases the risk of stroke and is an independent predictor of mortality . Available pharmacological treatments have limited efficacy . Once initiated , AF tends to self-perpetuate , owing in part to electrophysiological remodeling in the atria ; however , the fundamental mechanisms underlying this process are still unclear . We have recently demonstrated that chronic human AF is associated with increased atrial oxidative stress and peroxynitrite formation ; we have now tested the hypothesis that these events participate in both pacing-induced atrial electrophysiological remodeling and in the occurrence of AF following  cardiac surgery . In chronically instrumented dogs , we found that rapid ( 400 min−1 ) atrial pacing was associated with attenuation of the atrial effective refractory period ( ERP ) . Treatment with ascorbate , an antioxidant and peroxynitrite decomposition catalyst , did not directly modify the ERP , but attenuated the pacing-induced atrial ERP shortening following 24 to 48 hours of pacing . Biochemical studies revealed that pacing was associated with decreased tissue ascorbate levels and increased protein nitration ( a biomarker of peroxynitrite formation ) . Oral ascorbate supplementation attenuated both of these changes . To evaluate the clinical significance of these observations , supplemental ascorbate was given to 43 patients before , and for 5 days following , cardiac bypass graft surgery . Patients receiving ascorbate had a 16.3 % incidence of postoperative AF , compared with 34.9 % in control subjects . In combination , these studies suggest that oxidative stress underlies early atrial electrophysiological remodeling and offer novel insight into the etiology and potential treatment of an enigmatic and difficult to control arrhythmia . The full text of this article is available at http://www.circresaha.org Atrial fibrillation ( AF ) represents the most common sustained cardiac arrhythmia in patients with heart failure ( HF ) . AF in HF patients is associated with worsening of symptoms and also results in a substantial increase in mortality . Although HF patients in sinus rhythm have a better outcome than patients with AF , several r and omized studies investigating pharmacological rhythm control versus rate control have shown no advantage of one strategy over the other in terms of patient outcomes . Catheter-based ablation therapy is a newer therapeutic option with a rapidly evolving and changing role in the management of this arrhythmia . In the present review , the authors discuss the epidemiology , pathophysiology and prognostic significance of AF in patients with HF . Exclusively addressed are studies investigating catheter-based ablation for rhythm-control and rate-control therapies in the management of AF in HF patients Chronic atrial fibrillation ( AF ) is a common arrhythmia with significant morbidity and mortality . AF has been the subject of considerable attention and intensive clinical research in recent years . Current opinion on the management of AF favors the restoration and maintenance of normal ventricular rhythm . This has several potential benefits , including the alleviation of arrhythmia-associated symptoms and hemodynamic improvements . Maintenance of frequents normalization of ventricular rhythm ( NVR ) can be achieved with antiarrhythmic drug therapy or with AV node radiofrequency ablation ( RFA ) and permanent ventricular pacing . Recent interest has focused on the use of class III antiarrhythmic agents , such as amiodarone hydrochloride . This investigation compared amiodarone to AV node RFA and permanent pacing of the His-bundle area in maintaining NVR in patients with resistant chronic AF . After 12 months of treatment with amiodarone ( 200 to 400 mg/d ) 30 % of patients remained in NVR , 30 % were in transitional phase of improvement , and 40 % showed negative effect . Only a few patients in this group developed ocular or hepatic side effects . On one year follow-up was achieved in 100 % of cases without any clinical ly significant side effects being seen . In conclusion , analysis of the results of this study suggests that low-dose amiodarone is well tolerated in the management of chronic AF in a selected patient population . The more aggressive interventional radiofrequency ablation technique is significantly more effective and more reliable in the long-term clinical treatment of drug-resistant AF Background —Postoperative atrial arrhythmias are common and are associated with considerable morbidity . This study was design ed to evaluate the efficacy and safety of vernakalant for the conversion of  atrial fibrillation ( AF ) or  atrial flutter ( AFL ) after cardiac surgery . Methods and Results —This was a prospect i ve , r and omized , double-blind , placebo-controlled trial of vernakalant for the conversion of AF or AFL  after coronary artery bypass graft , valvular surgery , or both . Patients were r and omly assigned 2:1 to receive a 10-minute infusion of 3 mg/kg vernakalant or placebo . If AF or AFL was present after a 15-minute observation period , then a second 10-minute infusion of 2 mg/kg vernakalant or placebo was given . The primary end point was the conversion of postcardiac surgery AF or AFL to sinus rhythm within 90 minutes of dosing . In patients with AF , 47 of 100 ( 47 % ) who received vernakalant converted to SR compared with 7 of 50 ( 14 % ) patients who received placebo ( P<0.001 ) . The median time to conversion was 12 minutes . Vernakalant was not effective in converting postoperative AFL to sinus rhythm . Two serious adverse events occurred within 24 hours of vernakalant administration ( hypotension and complete atrioventricular block ) . There were no cases of torsades de pointes , sustained ventricular tachycardia , or ventricular fibrillation . There were no deaths . Conclusions —Vernakalant was safe and effective in the rapid conversion of AF to sinus rhythm in patients who had AF after cardiac surgery . Clinical Trial Registration — clinical trials.gov . Identifier : NCT00125320 BACKGROUND Inflammation and oxidative stress are associated with atrial fibrillation ( AF ) .  Statins have antioxidant and anti-inflammatory properties . We tested if atorvastatin reduced AF recurrence after DC cardioversion ( CV ) by modifying systemic oxidative stress and inflammation ( NCT00252967 ) . METHODS AND RESULTS In a r and omized , double-blinded , placebo-controlled trial , patients with atrial fibrillation/flutter ( AF ) were r and omized to receive either  atorvastatin 80 mg ( n = 33 )  or placebo ( n = 31 ) before CV . Treatment was continued for 12 months or until AF recurred . Serum oxidative stress markers ( ratios of oxidized to reduced glutathione and cysteine , derivatives of reactive oxygen species , isoprostanes ) and inflammatory markers ( high-sensitivity C- reactive protein [ hs-CRP ] , interleukin-6 [ IL-6 ] , interleukin-1β[IL-1β ] , tumor necrosis factor alpha [ TNFα ] ) were measured at baseline and on follow-up . AF recurred in 22 ( 66.7 % ) of atorvastatin and 26 ( 83.9 % ) of placebo group ( P = 0.2 ) . The adjusted hazard ratio of having recurrence on atorvastatin versus on placebo was 0.99 ( 95 % CI : 0.98 - 1.01 , P = 0.3 ) . There was no significant difference in the time to recurrence using Kaplan-Meier survival estimates ( median [ IR ] : 29 [ 2 - 145 ] days versus 22 [ 7 - 70 ] days , P = 0.9 ) . Although no significant effect was seen on oxidative stress , 2 of 4 inflammatory markers , IL-6 ( adjusted OR : 0.59 , 95 % CI : 0.35 - 0.97 , P = 0.04 ) and hs-CRP ( adjusted OR : 0.59 , 95 % CI : 0.37 - 0.95 , P = 0.03 ) were significantly lowered with atorvastatin  . Cholesterol levels significantly decreased with atorvastatin ( P = 0.03 ) . CONCLUSIONS High-dose atorvastatin did not reduce the recurrence of AF after CV . It reduced selective markers of inflammation without affecting systemic oxidative stress . Failure of atorvastatin to prevent AF recurrence may be due to its failure to affect oxidative stress BACKGROUND Atrial fibrillation ( AF ) is the most common sustained cardiac arrhythmia imposing substantial morbidity and mortality . Catheter-based pulmonary vein isolation ( PVI ) using radiofrequency current ( RFC ) has become a st and ard treatment for drug-resistant and symptomatic paroxysmal AF ( PAF ) . In recent years , the cryoballoon-based technique is increasingly used as a promising alternative with a short learning curve . METHODS The FIRE AND ICE trial is a prospect i ve , r and omized , controlled , open , blinded outcome assessment , noninferiority trial comparing cryoballoon- , and RFC-based PVI .  Patients with drug-resistant PAF will be r and omized in a 1:1 matrix in multiple European centers . The primary hypothesis is that cryoballoon ablation is not inferior to RFC ablation using 3-dimensional mapping with respect to clinical efficacy . The primary endpoint is defined as the time to first documented clinical failure , including : ( 1 ) recurrence of AF ; ( 2 ) atrial flutter or atrial tachycardia ; ( 3 ) prescription of class I or III antiarrhythmic drugs ; or ( 4 ) re-ablation , whichever comes first , following a blanking period of 3 months after the index ablation procedure . The primary safety endpoint is a composite of death , stroke/transient ischemic attack , cardiac arrhythmias ( apart from AF recurrence ) causally related to the therapeutic intervention , and procedure-related serious adverse events . CONCLUSION The FIRE AND ICE trial compares 2 different technologies to perform catheter ablation of PAF with respect to efficacy and safety . It aims at providing objective data to guide selection and usage of ablation catheters in the treatment of AF BACKGROUND Atrial fibrillation ( AF ) is the most common arrhythmia in clinical practice and is particularly common in the elderly . Although effects of fish intake , including potential antiarrhythmic effects , may favorably influence risk of AF , relationships between fish intake and AF incidence have not been evaluated . METHODS AND RESULTS In a prospect i ve , population -based cohort of 4815 adults > or = age 65 years , usual dietary intake  was assessed at baseline in 1989 and 1990 . Consumption of tuna and other broiled or baked fish correlated with plasma phospholipid long-chain n-3 fatty acids , whereas consumption of fried fish or fish s and wiches ( fish burgers ) did not . AF incidence was prospect ively ascertained on the basis of hospital discharge records and annual electrocardiograms . During 12 years ' follow-up , 980 cases of incident AF were diagnosed . In multivariate analyses , consumption of tuna or other broiled or baked fish was inversely associated with incidence of AF , with 28 % lower risk with intake 1 to 4 times per week ( HR=0.72 , 95 % CI=0.58 to 0.91 , P=0.005 ) , and 31 % lower risk with intake > or = 5 times per week ( HR=0.69 , 95 % CI=0.52 to 0.91 , P=0.008 ) , compared with < 1 time per month ( P trend=0.004 ) . Results were not material ly different after adjustment for preceding myocardial infa rct ion or congestive heart failure . In similar analyses , fried fish/fish s and wich consumption was not associated with lower risk of AF . CONCLUSIONS Among elderly adults , consumption of tuna or other broiled or baked fish , but not fried fish or fish s and wiches , is associated with lower incidence of AF . Fish intake may influence risk of this common cardiac arrhythmia OBJECTIVES This study assessed the relationship between atrial fibrillation ( AF ) and outcomes in the TOPCAT ( Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist ) trial , to evaluate whether AF modified the treatment response to spironolactone and whether spironolactone influenced post-r and omization AF . BACKGROUND AF is common in heart failure with preserved ejection fraction ( HFpEF ) and likely contributes to increased risk of adverse outcomes . METHODS A total 1,765 patients enrolled in TOPCAT trial in North and South America were divided into 3 groups : no known AF , history of AF without AF at enrollment  , and AF found on the electrocardiogram ( ECG ) at enrollment . We assessed outcomes and treatment response to spironolactone in all groups , and the association between post-r and omization AF and outcomes in patients free of AF at baseline . The primary outcome of the TOPCAT trial was a composite of cardiovascular mortality , aborted cardiac arrest , or heart failure hospitalization . RESULTS A total of 760 patients ( 43 % ) had a history of AF ( 18 % ) or AF on ECG at enrollment ( 25 % ) . The highest adjusted risk was associated with AF at enrollment ( primary outcome , hazard ratio : 1.34 ; 95 % confidence interval : 1.09 to 1.65 ; p = 0.006 ; and an increased early risk of secondary outcomes ) . Neither history of AF nor AF at enrollment modified the beneficial treatment effect of spironolactone . Post-r and omization AF , which occurred in 6.3 % of patients , was not influenced by spironolactone treatment , but was associated with an increased early risk of the primary outcome ( hazard ratio : 2.32 ; 95 % confidence interval : 1.59 to 3.40 ; p < 0.0001 ) and secondary outcomes . CONCLUSIONS AF at enrollment was associated with increased cardiovascular risk in HFpEF patients in the TOPCAT study . Post-r and omization AF , which was associated with an increased risk of morbidity and mortality , was not influenced by spironolactone . ( Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist [ TOPCAT ] ; NCT00094302 ) BACKGROUND Inflammation and oxidative stress have been recently implicated in the pathophysiology of atrial fibrillation ( AF ) . The aim of this study was to examine the potential benefit of vitamin C on the early recurrence rates and on inflammatory indices after successful cardioversion of persistent AF , as well as to investigate the time course of changes in these indices post-cardioversion . METHODS We prospect ively studied 44 consecutive patients after successful electrical cardioversion of persistent AF .  All patients received st and ard treatment and were r and omised in one to one fashion to either oral vitamin C administration or no additional therapy . We followed-up the patients for 7 days performing successive measurements of white blood cell ( WBC ) count , C-reactive protein ( CRP ) , fibrinogen , and ferritin levels . RESULTS One week after successful cardioversion , AF recurred in 4.5 % of patients in the vitamin C group and in 36.3 % of patients in the control group ( p=0.024 ) . Compared to baseline values , inflammatory indices decreased after cardioversion in patients receiving vitamin C but did not change significantly in the control group . A significant variance was found in the serial measurements of WBC counts ( F=5.86 , p=0.001 ) and of fibrinogen levels ( F=4.10 , p=0.0084 ) in the two groups . In the vitamin C group CRP levels were lower on the seventh day ( p<0.05 ) . CRP and fibrinogen levels were higher in patients who relapsed into AF compared to patients who maintained sinus rhythm ( F=2.77 , p=0.044 and F=3.51 , p=0.017 , respectively ) . CONCLUSIONS These findings suggest that vitamin C reduces the early recurrence rates after cardioversion of persistent AF and attenuates the associated low-level inflammation . These effects indicate that therapeutic approaches targeting at inflammation and oxidative stress may exert favourable effects on atrial electrical remodeling Background : Atrial fibrillation ( AF ) is a common cardiac arrhythmia which increases morbidity and mortality . Identification of risk factors is therefore important . We examined the impact of palpitations and cardiovascular risk factors in prediction of AF ( all types ) and lone AF in a large population -based cohort . Design : We carried out a prospect i ve population -based cohort study . Methods : A total of 22,815 participants from a population survey in 1994–1995 were followed-up for a mean of 11.1 years . Mean age at baseline was 46 years . Measurements of height , weight , blood pressure , heart rate , total cholesterol and high-density lipoprotein (HDL)-cholesterol , and information on palpitations , diabetes , angina , myocardial infa rct ion , and antihypertensive treatment were obtained at baseline . The outcome measure was first-ever AF , documented on an electrocardiogram .  Cox proportional hazards regression model was used to estimate hazard ratios ( HRs ) for AF . Results : Palpitations were associated with increased risk of AF in both women ( HR 1.62 , 95 % confidence interval [ CI ] 1.29–2.02 ) and men ( HR 1.91 , 95 % CI 1.54–2.35 ) . For hypertension the HR for AF was 1.98 ( 1.46 - 2.69 ) in women and 1.40 ( 1.13 - 1.74 ) in men . The HR for 1 SD increase in body mass index ( BMI ) was 1.16 ( 1.06–1.27 ) in women and 1.47 ( 1.32–1.63 ) in men . Body height and BMI were associated with increased risk for lone AF in men . Conclusion : Palpitations , hypertension and BMI were predictive of future atrial fibrillation in both sexes BACKGROUND Postoperative arrhythmias are among the most common complications of cardiac surgery . Total serum magnesium concentration will change after coronary bypass surgery but compensatory prophylactic administration of magnesium has remained a controversial issue . We studied whether prophylactic administration of magnesium could prevent post-coronary artery bypass grafting ( CABG ) arrhythmias and evaluated the effects of diabetes mellitus on prophylactic magnesium administration . METHODS In a clinical trial , 345 consecutive CABG c and i date s were r and omly assigned to study ( n = 166 , 48.1 % ) and control groups . Patients in study group received supplemental magnesium infusion as following : 2 g [ corrected ] after induction of anesthesia until cardio-pulmonary bypass and then 8 g upon arrival in Intensive Care Unit ( ICU ) until 24 hr . Total serum magnesium concentration was measured at four design ated time points : onset of induction , and 0 , 24 and 48 hr after ICU admission . Cardiac arrhythmias were sought with a 12-lead electrocardiogram ( ECG ) from the end of surgery up till discharge . RESULTS Atrial Fibrillation ( Af ) occurred in 34 patients ( 9.9 % ) . Total serum magnesium concentration was significantly higher in patients who received supplemental magnesium ( P < 0.001 ) and significantly lower in Af patients ( P= 0.02 ) . Among non-diabetics , Af incidence was significantly lower in study group compared with control group . CONCLUSIONS The occurrence of atrial fibrillation correlates with serum magnesium level . Diabetes mellitus probably hampers prophylactic effect of supplemental magnesium in preventing the occurrence of Af BACKGROUND Atrial fibrillation ( AF ) is associated to a high risk of systemic embolism . The mechanisms that contribute to thrombogenesis in these patients are still poorly understood . Systemic and /or local inflammation could be involved in the process of thrombogenesis and contribute to the perpetuation of the arrhythmia . The purpose of the study was to evaluate the role of inflammation and its relation to thrombogenesis and cardiac rhythm in AF . METHODS We prospect ively studied 130 patients with newly diagnosed non-valvular AF in absence of antithrombotic therapy . Determinations of C-reactive protein ( CRP ) and thrombin-antithrombin complex ( TAT ) plasma levels , along with a transesophageal echocardiogram  were performed in all the patients at admission . RESULTS Mean age of the group was 67+/-14 years .  CRP levels were significantly elevated in AF patients versus controls ( matched by age , gender and cardiovascular risk factors ) ( 1.0+/-1.8 versus 0.3+/-0.4 mg/dl , respectively , p<0.01 ) . Baseline TAT levels were also significantly elevated in AF patients but no correlation was found between CRP and TAT . At 1-year of follow-up , mean CRP levels were still elevated in patients that remained in AF compared to those who converted to sinus rhythm ( 1.2+/-1.8 compared to 0.5+/-1.5 mg/dl , p=0.03 ) . CRP was the only biochemical predictor of sinus rhythm maintenance at 1-year follow-up independently of clinical ( including adjustment for risk factors and antiarrhythmic drugs ) , biochemical and echo parameters . CONCLUSIONS There is evidence for the presence of inflammation in patients with non-valvular AF , which is not related to activation of the coagulation cascade . The persistence of inflammation is associated with chronic AF at 1-year follow up Background —It has been suggested that inflammation can have a role in the development of atrial arrhythmias after cardiac surgery and that a genetic predisposition to develop postoperative complications exists . This study was conceived to verify if a potential genetic modulator of the systemic inflammatory reaction to cardiopulmonary bypass ( the −174 G/C polymorphism of the promoter of the Interleukin-6 gene ) has a role in the pathogenesis of postoperative atrial fibrillation ( AF ) . Patients and Results —In 110 primary isolated coronary artery bypass patients the −174G/C Interleukin-6 promoter gene variant was determined . Interleukin-6 , fibrinogen and C-reactive protein plasma levels were determined preoperatively , 24 , 48 , and 72 hours after surgery and at discharge . Heart rate and rhythm were continuously monitored for the first 36 to 48 hours ; daily 12-lead electrocardiograms were performed thereafter until discharge . GG , CT , and CC genotypes were found in 62 , 38 , and 10 patients , respectively . Multivariate analysis ( which included genotype , age , sex , and classical risk factors for AF ) identified the GG genotype as the only independent predictor of postoperative AF . The latter occurred in 33.9 % of GG versus 10.4 % of non-GG patients ( hazard ratio 3.25 , 95%CI 1.23 to 8.62 ) . AF patients  had higher blood levels of Interleukin-6 and fibrinogen after surgery ( P < 0.001 for difference between the area under the curve ) . Conclusion —The −174G/C Interleukin-6 promoter gene variant appears to modulate the inflammatory response to surgery and to influence the development of postoperative AF . These data suggest an inflammatory component of postoperative atrial arrhythmias and a genetic predisposition to this complication BACKGROUND Atrial fibrillation ( AF ) is a very common cardiac arrhythmia , and is associated with an increased mortality in patients with hypertension . Whether the best therapeutic approach for these patients is to restore sinus rhythm ( SR ) or to adequately control the ventricular rate is still controversial . The aim of this study is to compare both strategies in patients with hypertension . METHODS AND RESULTS Two hundred and twenty-one patients with hypertension and AF of duration > 48 h were r and omly assigned to either the rhythm ( n=155 ) or rate ( n=66 ) control group . Exercise capacity was improved in the rhythm control group in the 1st year of the study ( p<0.0001 ) . There were no statistically significant differences in the embolic event rate and the total mortality between the 2 groups at the end of the study ( p = NS ) . CONCLUSIONS Although restoring and maintaining SR had a beneficial effect on exercise capacity in patients with hypertension and AF , no significant difference was found in terms of the total mortality and the embolic event rates . Thus , rate control is an acceptable primary strategy in patients with AF and hypertension OBJECTIVES This study was design ed to compare two treatment strategies in patients with atrial fibrillation(AF ) :  rhythm-control ( restoration and maintenance of sinus rhythm ) and rate-control ( pharmacologic or invasive rate-control and anticoagulation ) . BACKGROUND Atrial fibrillation is the most common arrhythmia . It is unclear whether a strategy of rhythm- or rate-control is better in terms of mortality , morbidity , and quality of life . METHODS The Strategies of Treatment of Atrial Fibrillation ( STAF ) multicenter pilot trial r and omized 200 patients ( 100 per group ) with persistent AF to rhythm- or rate-control .  The combined primary end point was a combination of death , cardiopulmonary resuscitation , cerebrovascular event , and systemic embolism . RESULTS After 19.6 + /- 8.9 months ( range 0 to 36 months ) there was no difference in the primary end point between rhythm-control ( 9/100 ; 5.54%/year ) and rate-control ( 10/100 ; 6.09%/year ; p = 0.99 ) . The percentage of patients in sinus rhythm in the rhythm-control group after up to four cardioversions during the follow-up period ( rate-control group ) was 23 % ( 0 % ) at 36 months . Eighteen primary end points occurred in atrial fibrillation ; only one occurred in sinus rhythm ( p = 0.049 ) . CONCLUSIONS The STAF pilot study showed no differences between the two treatment strategies in all end points except hospitalizations . These data suggest that there was no benefit in attempting rhythm-control in these patients with a high risk of arrhythmia recurrence . It remains unclear whether the results in the rhythm-control group would have been better if sinus rhythm had been maintained in a higher proportion of patients , as all but one end point occurred during AF Background — Atrial arrhythmias are common early after atrial fibrillation ( AF ) ablation . We hypothesized that empirical antiarrhythmic drug ( AAD ) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias . Methods and Results — We r and omized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy ( AAD group ) or no antiarrhythmic therapy ( no-AAD group ) for the first 6 weeks after ablation . In the no-AAD group , only atrioventricular nodal blocking agents were prescribed . All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks . The primary end point of the study was a composite of ( 1 ) atrial arrhythmias lasting more than 24 hours ; ( 2 ) atrial arrhythmias associated with severe symptoms requiring hospital admission , cardioversion , or initiation/change of antiarrhythmic drug therapy ; and ( 3 ) intolerance to antiarrhythmic agent requiring drug cessation .  Of 110 enrolled patients ( age 55±9 years , 71 % male ) , 53 were r and omized to AAD and 57 to no-AAD . There was no difference in baseline characteristics between groups . During the 6 weeks after ablation , fewer patients reached the primary end point in the AAD compared with the no-AAD group ( 19 % versus 42 % ; P=0.005 ) . There remained fewer events in the AAD group ( 13 % versus 28 % ; P=0.05 ) when only end points of AF > 24 hours , arrhythmia-related hospitalization , or electrical cardioversion were compared . Conclusions — AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinical ly significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management Atrial fibrillation ( AF ) is a common arrhythmia , after cardiac surgery , and it is associated with a twofold increase in cardiovascular mortality and morbidity . Reperfusion injury and inflammation associated with cardiac surgery are thought to be involved in its pathogenesis . Heat shock proteins ( HSPs ) are a family of chaperone proteins which assist in preservation of cellular integrity by maintaining proteins in their correctly folded state . The aim of this study was to investigate pre-postoperative heat shock protein70 ( HSP70 ) and high-sensitivity C-reactive protein in serum from patients in preoperative sinus rhythm . We prospect ively screened 45 consecutive patients admitted to the hospital for elective coronary artery bypass surgery ( CABG ) .  Electrocardiogram characteristics and cardiovascular risk profile were documented . Pre- and postoperative blood sample s were collected . HSP70 value was 8.9 + /- 4.8 ng/mL in Group A ( study group ) preoperatively and decreased to 7.7 + /- 7.0 ng/mL postoperatively . In contrast , preoperative value of HSP70 was 4.2 + /- 2.2 ng/mL and decreased to 2.7 + /- 2.6 ng/mL postoperatively in Group B ( control group ) . Statistical analysis showed significant difference regarding preoperative HSP70 levels in Group A compared to Group B. To our knowledge , with this study , the association of pre- and postoperative circulating HSP70 with postoperative AF was demonstrated for the first time BACKGROUND Atrial fibrillation ( AF ) is the most common sustained cardiac arrhythmia and it is associated with an increased stroke risk , due mainly to cardiac embolism from the left atrial appendage ( LAA ) . Percutaneous LAA closure is a method to reduce stroke risk in AF without using anticoagulant agents . In this study we report data from an Italian experience with the LAA occluder Amplatzer Cardiac Plug ( ACP ) device ( Aga Medical Corporation , Plymouth , MN , USA ) . METHODS The study was design ed to evaluate the safety of LAA closure using ACP and the efficacy of the procedure in preventing strokes during a 1-year follow-up . Patients with permanent or paroxysmal AF , high stroke risk , and contraindication to warfarin therapy were selected for the procedure . RESULTS The LAA closure was attempted in 37 patients and succeeded in 34 cases ( 91.9 % ) . Four patients experienced serious complications ( one cardiac tamponade requiring pericardiocentesis , two device embolizations , one low-rate response AF requiring artificial pacing ) . During a 1-year follow-up , ischemic stroke occurred in one of 34 patients , result ing in a stroke rate of 2.94 % ; thus there was a stroke rate reduction of 50.2 % and 26.5 % compared to the expected stroke rate , according to CHADS2 and CHA2 DS2 VASc score . None of the patients who received ACP experienced major bleeding during the follow-up . CONCLUSION LAA closure using ACP is a relatively feasible procedure which can be performed by highly experienced operators to reduce stroke rate in patients with AF , high stroke risk , and contraindication to oral anticoagulants BACKGROUND The ideal management of patients with newly diagnosed symptomatic atrial fibrillation ( AF ) remains unknown . Current practice guidelines recommend a trial of antiarrhythmic drugs ( AAD ) prior to considering an invasive ablation procedure . However , earlier ablation offers an opportunity to halt the progressive patho-anatomical changes associated with AF , as well as impart other important clinical benefits . OBJECTIVE The aim of this study is to determine the optimal initial management strategy for patients with newly diagnosed , symptomatic atrial fibrillation . METHODS / DESIGN The EARLY-AF study ( Clinical Trials.govNCT02825979 ) is a prospect i ve , open label , multicenter , r and omized trial with a blinded assessment of outcomes . A total of 298 patients will be r and omized in a 1:1 fashion to first-line AAD therapy , or first-line cryoballoon-based pulmonary vein isolation .  Patients with symptomatic treatment naïve AF will be included . Arrhythmia outcomes will be assessed by implantable cardiac monitor ( ICM ) . The primary outcome is time to first recurrence of AF , atrial flutter , or atrial tachycardia ( AF/AFL/AT ) between days 91 and 365 following AAD initiation or AF ablation . Secondary outcomes include arrhythmia burden , quality of life , and healthcare utilization . DISCUSSION The EARLY-AF study is a r and omized trial design ed to evaluate the optimal first management approach for patients with AF . We hypothesize that catheter ablation will be superior to drug therapy in prevention of AF recurrence BACKGROUND Atrial fibrillation ( AF ) is the most common sustained arrhythmia with serious clinical consequences in the absence of treatment . However , there are limited data on the treatment of these patients in Argentina . The objective was to describe the therapeutic management of patients with nonacute AF by Argentinean cardiologists and to determine the incidence of clinical events after 12 months follow-up . METHODS The Atrial Fibrillation study in Argentina ( FARAON ) was an observational , descriptive , prospect i ve , national , and multicentric study that included out patients with AF , followed for 12 months . The study included 38 sites in Argentina . Each research er included the first 10 patients who met the inclusion criteria of being over 21 and also being an AF carrier documented by electrocardiogram or Holter within 12 months prior to or at the time of enrollment . RESULTS A total of 373 patients were included , mean age 70 ± 11.5 years , 40 % women ; 65 % had AF rhythm at the time of inclusion , 57 % had permanent AF , and 56 % were asymptomatic . At the time of enrollment , 40 % of physicians opted for rhythm control strategy . β-blockers and amiodarone were the most used drugs . Patients with rhythm control drugs had higher success rate than those with frequency control drug therapy ( 80 % vs 57 % ) . CONCLUSION Cardiologists in Argentina receive patients with AF that are mostly permanent AF . More than half of the patients are asymptomatic . They opt primarily by controlling the pace . When choosing antiarrhythmic drugs , nearly half of them indicated amiodarone BACKGROUND Atrial fibrillation occurs after approximately 25 % to 45 % of coronary artery bypass graft ( CABG ) surgeries . Oxidative stress and related electrophysiological remodeling has been proposed as a potential cause of this atrial fibrillation . Perioperative supplementation of the antioxidant ascorbic acid has been evaluated as a preventive agent . The current investigation was conducted to evaluate the efficacy of ascorbic acid in reducing atrial fibrillation  in CABG patients . METHODS A prospect i ve , r and omized , placebo-controlled , triple-blind , single-institution study was conducted in nonemergency CABG patients . Subjects were monitored for episodes of arrhythmia and other complications . RESULTS Eighty-nine treatment and 96 control subjects completed the study protocol . Demographics , comorbidities , and preoperative drugs were similar between groups . Surgical characteristics and postoperative medication use also were similar . The incidence of atrial fibrillation was 30.3 % in the treatment group and 30.2 % in the control group ( P = .985 ) . No difference was found in postoperative complications or mortality . CONCLUSIONS Our data indicate that supplementation of ascorbic acid in addition to routine postoperative care does not reduce atrial fibrillation after coronary artery bypass grafting Background —In patients with left ventricular dysfunction , atrial fibrillation and flutter ( AF and AFl , respectively ) are common arrhythmias associated with increased morbidity and mortality . The present study investigated the potential of dofetilide in AF-AFl patients with left ventricular dysfunction to restore and maintain sinus rhythm , which might reduce mortality and hospitalizations . Methods and Results —In the Danish Investigations of Arrhythmia and Mortality ON  Dofetilide  ( DIAMOND ) studies , 506 patients were in AF-AFl at baseline . Over the course of study , cardioversion occurred in 148 ( 59 % ) dofetilide- and 86 ( 34 % ) placebo-treated patients . In these patients , the probability of maintaining sinus rhythm for 1 year was 79 % with dofetilide versus 42 % with placebo ( P < 0.001 ) . Dofetilide had no effect on all-cause mortality , but restoration and maintenance of sinus rhythm was associated with significant reduction in mortality ( risk ratio [ RR ] , 0.44 ; 95 % CI , 0.30 to 0.64;P < 0.0001 ) . In addition , dofetilide therapy was associated with a significantly lower risk ratio versus placebo for either all-cause ( RR , 0.70 ; 95 % CI , 0.56 to 0.89;P ≤0.005 ) or congestive heart failure ( RR , 0.69 ; 95 % CI , 0.51 to 0.93;P ≤0.02 ) rehospitalization . Conclusions —Dofetilide is safe and increases the probability of obtaining and maintaining sinus rhythm in patients with structural heart disease . The present study suggests that restoration of sinus rhythm is associated with improved survival
Conclusions Our meta- analysis indicates that vitamin C may prevent post-operative atrial fibrillation in some countries outside of the USA , and it may also shorten the duration of hospital stay and ICU stay of cardiac surgery patients .
Vitamin C is an essential nutrient that is safe and inexpensive .
Background Atrial fibrillation ( AF ) , a common arrhythmia contributing substantially to cardiac morbidity , is associated with oxidative stress and , being an antioxidant , vitamin C might influence it .