To Be or Not To Be in Normal Sinus Rhythm: What Do We Really Know?
Authors: Tristram D. Bahnson, Augustus O. Grant
Journal: Annals of Internal Medicine (2004)

Editorials2 November 2004To Be or Not To Be in Normal Sinus Rhythm: What Do We Really Know?Tristram D. Bahnson, MD and Augustus O. Grant, MB, PhDTristram D. Bahnson, MDFrom Duke University Medical Center, Durham, NC 27710.Search for more papers by this author and Augustus O. Grant, MB, PhDFrom Duke University Medical Center, Durham, NC 27710.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-9-200411020-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The high prevalence of atrial fibrillation and the shortcomings of currently available therapies fuel continued discussion of best clinical practice. The recent publication of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial (1), the largest randomized trial of management strategies for atrial fibrillation, seemed to resolve a major issue: Rate control and the use of anticoagulation are equivalent to restoring and maintaining normal sinus rhythm by using contemporary antiarrhythmic drugs.In this issue, Marshall and colleagues (2) provide additional analyses of the AFFIRM database—a comparison of the cost-effectiveness of rate control versus rhythm control of atrial fibrillation. The ...References1. Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al . A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347:1825-33. [PMID: 12466506] CrossrefMedlineGoogle Scholar2. Marshall DA, Levy AR, Vidaillet H, Fenwick E, Slee A, Blackhouse G, et al . Cost-effectiveness of rhythm versus rate control in atrial fibrillation. Ann Intern Med. 2004;141:653-61. LinkGoogle Scholar3. Zimetbaum P, Josephson ME. Is there a role for maintaining sinus rhythm in patients with atrial fibrillation? Ann Intern Med. 2004;141:720-6. LinkGoogle Scholar4. Wyse DG. Overview of endpoints in atrial fibrillation studies. Heart Rhythm. 2004;1:B3-7. CrossrefMedlineGoogle Scholar5. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al . Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370-5. [PMID: 11343485] CrossrefMedlineGoogle Scholar6. Baseline characteristics of patients with atrial fibrillation: the AFFIRM Study. Am Heart J. 2002;143:991-1001. [PMID: 12075254] CrossrefMedlineGoogle Scholar7. Pedersen OD, Bagger H, Keller N, Marchant B, Kober L, Torp-Pedersen C. 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. Circulation. 2001;104:292-6. [PMID: 11457747] CrossrefMedlineGoogle Scholar8. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98:946-52. [PMID: 9737513] CrossrefMedlineGoogle Scholar9. Corley SD, Epstein AE, DiMarco JP, Domanski MJ, Geller N, Greene HL, et al . Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation. 2004;109:1509-13. [PMID: 15007003] CrossrefMedlineGoogle Scholar10. McNamara RL, Tamariz LJ, Segal JB, Bass EB. Management of atrial fibrillation: review of the evidence for the role of pharmacologic therapy, electrical cardioversion, and echocardiography. Ann Intern Med. 2003;139:1018-33. [PMID: 14678922] LinkGoogle Scholar11. Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, et al . Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med. 1991;324:781-8. [PMID: 1900101] CrossrefMedlineGoogle Scholar12. Waldo AL, Camm AJ, deRuyter H, Friedman PL, MacNeil DJ, Pauls JF, et al . Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD Investigators. Survival With Oral d-Sotalol. Lancet. 1996;348:7-12. [PMID: 8691967] CrossrefMedlineGoogle Scholar13. Flaker GC, Blackshear JL, McBride R, Kronmal RA, Halperin JL, Hart RG. Antiarrhythmic drug therapy and cardiac mortality in atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators. J Am Coll Cardiol. 1992;20:527-32. [PMID: 1512329] CrossrefMedlineGoogle Scholar14. Pappone C, Rosanio S, Augello G, Gallus G, Vicedomini G, Mazzone P, et al . Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol. 2003;42:185-97. [PMID: 12875749] CrossrefMedlineGoogle Scholar15. Oral H, Scharf C, Chugh A, Hall B, Cheung P, Good E, et al . Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation. 2003;108:2355-60. [PMID: 14557355] CrossrefMedlineGoogle Scholar16. Snow V, Weiss KB, LeFevre M, McNamara R, Bass E, Green LA, et al . Management of newly detected atrial fibrillation: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Intern Med. 2003;139:1009-17. [PMID: 14678921] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Duke University Medical Center, Durham, NC 27710.Disclosures: Honoraria: A.O. Grant (Guidant Corp., Medtronic Corp.).Corresponding Author: Augustus O. Grant, MB, PhD, Cardiology Division, Box 3504, Duke University Medical Center, Durham, NC 27710; e-mail, [email protected]duke.edu.Current Author Addresses: Drs. Bahnson and Grant: Atrial Fibrillation Clinic, Duke University Medical Center, Durham, NC 27710. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCost-Effectiveness of Rhythm versus Rate Control in Atrial Fibrillation Deborah A. Marshall , Adrian R. Levy , Humberto Vidaillet , Elisabeth Fenwick , April Slee , Gordon Blackhouse , H. Leon Greene , D. George Wyse , Graham Nichol , Bernie J. O'Brien , and Is There a Role for Maintaining Sinus Rhythm in Patients with Atrial Fibrillation? Peter Zimetbaum and Mark E. Josephson Metrics Cited ByMedikamentöse Frequenzkontrolle bei VorhofflimmernUsing and interpreting cost-effectiveness acceptability curves: an example using data from a trial of management strategies for atrial fibrillationRhythm vs. rate control of atrial fibrillation meta-analysed by number needed to treat 2 November 2004Volume 141, Issue 9Page: 727-729KeywordsAtrial fibrillationCardiovascular therapyCathetersDrug regulationDrug therapyDrugsHeart failureMortalityRandomized trialsStroke ePublished: 2 November 2004 Issue Published: 2 November 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...