Clinical review: clinical management of atrial fibrillation - rate control versus rhythm control

Hoong Sern Lim, Ali Hamaad, Gregory Y H Lip, Hoong Sern Lim, Ali Hamaad, Gregory Y H Lip

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the critically ill and is associated with adverse outcomes. Although there are plausible benefits from conversion and maintenance of sinus rhythm (the so-called 'rhythm-control' strategy), recent randomized trials have failed to demonstrate the superiority of this approach over the rate-control strategy. Regardless of approach, continuous therapeutic anticoagulation is crucial for stroke prevention. This review addresses the findings of these studies and their implications for clinical management of patients with atrial fibrillation.

Figures

Figure 1
Figure 1
Treatment algorithm for atrial fibrillation. aConsider anticoagulation and early cardioversion if symptomatic. bRefer to Table 5. INR, international normalized ratio; LV, left ventricular.
Figure 2
Figure 2
Risk stratification for anticoagulation treatment. INR, international normalized ratio.

References

    1. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. 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;285:2370–2375. doi: 10.1001/jama.285.18.2370.
    1. Lip GYH. Does atrial fibrillation confer a hypercoagulable state? Lancet. 1995;346:1313–1314. doi: 10.1016/S0140-6736(95)92339-X.
    1. 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;98:946–952.
    1. Goldman L. Supraventricular tachyarrhythmias in hospitalised adults after surgery: clinical correlates in patients over 40 years of age after major noncardiac surgery. Chest. 1978;73:450–454.
    1. Lauer MS, Eagle KA, Buckley MJ, DeSanctis RW. Atrial fibrillation following coronary artery bypass surgery. Prog Cardiovasc Dis. 1989;31:367–378.
    1. Reinhelt P, Karth GD, Geppert A, Heinz G. Incidence and type of cardiac arrhythmias in critically ill patients: a single center experience in a medical-cardiological ICU. Intensive Care Med. 2001;27:1466–1473. doi: 10.1007/s001340101043.
    1. Artucio H, Pereira M. Cardiac arrhythmias in critically ill patients: epidemiologic study. Crit Care Med. 1990;18:1383–1388.
    1. Fuster V, Ryden LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, Halperin JL, Kay GN, Klein WW, Levy S, McNamara RL, Prystowsky EN, Wann LS, Wyse DG, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Hiratzka LF, Jacobs AK, Russell RO, Smith SC, Jr, Klein WW, Alonso-Garcia A, Blomstrom-Lundqvist C, de Backer G, Flather M, Hradec J, Oto A, Parkhomenko A, Silber S, Torbicki A, American College of Cardiology/American Heart Association Task Force on Practice Guidelines, European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation), North American Society of Pacing and Electrophysiology ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Circulation. 2001;104:2118–2150.
    1. Falk RH. Atrial fibrillation. N Engl J Med. 2001;344:1067–1078. doi: 10.1056/NEJM200104053441407.
    1. Clark DM, Plumb VJ, Epstein AE, Kay GN. Haemodynamic effects of an irregular sequence of ventricular cycle lenths during atrial fibrillation. J Am Coll Cardiol. 1997;30:1039–1045. doi: 10.1016/S0735-1097(97)00254-4.
    1. Brookes CI, White PA, Staples M, Oldershaw PJ, Redington AN, Collins PD, Noble MI. Myocardial contractility is not constant during spontaneous atrial fibrillation in patients. Circulation. 2002;98:1762–1768.
    1. Black IW, Fatkin D, Sagar KB, Khandheria BK, Leung DY, Galloway JM, Feneley MP, Walsh WF, Grimm RA, Stollberger C. Exclusion of atrial thrombus by transesophageal echocardiography does not preclude embolism after cardioversion of atrial fibrillation: a multicenter study. Circulation. 1994;89:2509–2513.
    1. Saxonhouse SJ, Curtis AB. Risks and benefits of rate control versus maintenance of sinus rhythm. Am J Cardiol. 2003;91:27D–32D. doi: 10.1016/S0002-9149(02)03376-3.
    1. Hohnloser SH, Kuck KH, Lilienthal J. Rhythm or rate control in atrial fibrillation – Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet. 2000;356:1789–1794. doi: 10.1016/S0140-6736(00)03230-X.
    1. Carlsson J, Miketic S, Windeler J, Cuneo A, Haun S, Micus S, Walter S, Tebbe U, STAF Investigators Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol. 2003;41:1690–1696. doi: 10.1016/S0735-1097(03)00332-2.
    1. Van Gelder IC, Hagens VE, Bosker HA, Kingma JH, Kamp O, Kingma T, Said SA, Darmanata JI, Timmermans AJ, Tijssen JG, Crijns HJ, Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study Group A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347:1834–1840. doi: 10.1056/NEJMoa021375.
    1. Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, Kellen JC, Greene HL, Mickel MC, Dalquist JE, Corley SD, Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347:1825–1833.
    1. David D, Di Segni E, Klein HO, Kaplinsky E. Inefficiency of digitalis in the control of heart rate in patients with chronic atrial fibrillation: beneficial effects of an added beta-adrenergic blocking agent. Am J Cardiol. 1979;44:1378–1382.
    1. DiBianco R, Morganroth J, Freitag RJ, Ronan JA., Jr Effects of nadolol on the spontaneous and exercise-provoked heart rate in patients with chronic atrial fibrillation receiving stable doses of digoxin. Am Heart J. 1984;108:1121–1127.
    1. Lundstrom T, Ryden L. Ventricular rate control and exercise performance in chronic atrial fibrillation: effects of diltiazem and verapamil. J Am Coll Cardiol. 1990;16:86–90.
    1. Schreck DM, Rivera AR, Tricarico VJ. Emergency management of atrial fibrillation and flutter: intravenous diltiazem versus intravenous digoxin. Ann Emerg Med. 1997;29:135–140.
    1. Farshi R, Kistner D, Sarma JS, Longmate JA, Singh BN. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens. J Am Coll Cardiol. 1999;33:304–310. doi: 10.1016/S0735-1097(98)00561-0.
    1. Clemo HF, Wood MA, Gilligan DM, Ellenbogen KA. Intravenous amiodarone for acute heart rate control in the critically ill patient with atrial tachyarrhythmias. Am J Cardiol. 1998;81:594–598. doi: 10.1016/S0002-9149(97)00962-4.
    1. Delle Karth G, Geppert A, Neunteufl T, Priglinger U, Haumer M, Gschwandtner M, Siostrzonek P, Heinz G. Amiodarone versus diltiazem for rate control in critically ill patients with atrial tachyarrhythmias. Crit Care Med. 2001;29:1149–1153. doi: 10.1097/00003246-200106000-00011.
    1. Chevalier P, Durand-Dubief A, Burri H, Cucherat M, Kirkorian G, Touboul P. Amiodarone versus placebo and classic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis. J Am Coll Cardiol. 2003;41:255–262. doi: 10.1016/S0735-1097(02)02705-5.
    1. Klein AL, Grimm RA, Murray RD, Apperson-Hansen C, Asinger RW, Black IW, Davidoff R, Erbel R, Halperin JL, Orsinelli DA, Porter TR, Stoddard MF, Assessment of Cardioversion Using Transesophageal Echocardiography Investigators Use of transoesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med. 2001;344:1411–1420. doi: 10.1056/NEJM200105103441901.
    1. Martinez-Marcos FJ, Garcia-Garmendia JL, Ortega-Carpio A, Fernandez-Gomez JM, Santos JM, Camacho C. Comparison of intravenous flecainide, propafenone, and amiodarone for conversion of acute atrial fibrillation to sinus rhythm. Am J Cardiol. 2000;86:950–953. doi: 10.1016/S0002-9149(00)01128-0.
    1. Kerin NZ, Faitel K, Naini M. The efficacy of intravenous amiodarone for the conversion of chronic atrial fibrillation. Amiodarone vs quinidine for conversion of atrial fibrillation. Arch Intern Med. 1996;156:49–53. doi: 10.1001/archinte.156.1.49.
    1. Nichol G, McAlister F, Pham B, Laupacis A, Shea B, Green M, Tang A, Wells G. Meta-analysis of randomised controlled trials of the effectiveness of antiarrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation. Heart. 2002;87:535–543. doi: 10.1136/heart.87.6.535.
    1. Roy D, Talajic M, Dorian P, Connolly S, Eisenberg MJ, Green M, Kus T, Lambert J, Dubuc M, Gagne P, Nattel S, Thibault B. Amiodarone to prevent recurrence of atrial fibrillation. Canadian Trial of Atrial Fibrillation Investigators. N Engl J Med. 2000;342:913–920. doi: 10.1056/NEJM200003303421302.
    1. The AFFIRM First Antiarrhythmic Drug Substudy Investigators Maintenance of sinus rhythm in patients with atrial fibrillation: an AFFIRM substudy of the first antiarrhythmic drug. J Am Coll Cardiol. 2003;42:20–29. doi: 10.1016/S0735-1097(03)00559-X.
    1. Lip GYH, Hart RG, Conway DS. Antithrombotic therapy for atrial fibrillation. BMJ. 2002;325:1022–1025. doi: 10.1136/bmj.325.7371.1022.
    1. Singh S, Zoble RG, Yellen L, Brodsky MA, Feld GK, Berk M, Billing CB., Jr Efficacy and safety of oral dofetilide in converting to and maintaining sinus rhythm in patients with chronic atrial fibrillation or atrial flutter: the symptomatic atrial fibrillation investigative research on dofetilide (SAFIRE-D) study. Circulation. 2000;102:2385–2390.
    1. Volgman AS, Carberry PA, Stambler B, Lewis WR, Dunn GH, Perry KT, Vanderlugt JT, Kowey PR. Conversion efficacy and safety of intravenous ibutilide compared with intravenous procainamide in patients with atrial flutter or fibrillation. J Am Coll Cardiol. 1998;31:1414–1419. doi: 10.1016/S0735-1097(98)00078-3.

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