atrial fibrillation, persistent
DISEASE INTERVENTION COMPARISON RESULTS
Heart. 2008 Feb;94(2):191-6. Epub 2007 May 4 Cohorts
IN atrial fibrillation, persistent The Use of
digitalis, digoxin
As Treatment, Chronic
Is worse Than
other rate control drugs
To modify mortality: 6.5% digitalis VS 4.1% non-digitalis, HR 1.53 after adjustement for other risk factors
J Am Coll Cardiol. 2005 Mar 1;45(5):705-11 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, hypertension, primary The Use of
angiotensin II receptor blockers, losartan
As Treatment, Chronic
Is better Than
beta-blockers
To reduce cardiovascular events (composite of cardiovascular mortality, stroke, and myocardial infarction): 36/171 patients with losartan VS 67/171 patients with B-blokers, at aprox 4 years
JAMA. 2005 Feb 9;293(6):690-8 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, direct thrombin inhibitors, ximelagatran
As Treatment, Chronic
Is equal Than
warfarin
To prevent, at 20 months, stroke (of any type): 1.6% xime. VS 1.2% warf. Elevated liver enzymes (>3N): 6% xime. VS 0.8% warf. Major bleeding similar. Finally dropped due to hepatic toxicity.
N Engl J Med. 2006 Mar 2;354(9):934-41 Randomized Controlled Trial
IN atrial fibrillation, persistent, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Acute
Is better Than
cardioversion and chronic amiodarone
To reduce atrial fibrillation recurrence: 26% with ablation VS 42% amiodarone; and improve symptoms. Complications: atypical atrial flutter.
N Engl J Med. 2002 Dec 5;347(23):1834-40 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is equal Than
rhythm control strategy
To reduce a composite of cardiovascular and treatment-related events: 17.2% in rate-control VS 22.6% in rhythm-control
Arch Intern Med. 2005 Feb 14;165(3):258-62 Meta-Analysis
IN atrial fibrillation, persistent, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is equal Than
rhythm control strategy
To reduce all-cause mortality at 2 to 3.5 years: 14.6% rhythm-control vs 13.0% rate-control. A trend existed in favour of rate-control: OR 0.87; 95%CI 0.74-1.02
Ann Intern Med. 2004 Nov 2;141(9):653-61 Cost-Effectiveness
IN atrial fibrillation, persistent, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is better Than
rhythm control strategy
To cost-effectiveness: rate control is always more effective and less costly