on March 8, 2004
Circulation. 2004
Published online before print March 8, 2004, doi: 10.1161/01.CIR.0000121736.16643.11
Published online before print March 8, 2004, doi: 10.1161/01.CIR.0000121736.16643.11
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Submitted on July 15, 2003
From the University of Alabama at Birmingham.
Background--The AFFIRM Study showed that treatment of patients with atrial fibrillation and a high risk for stroke or death with a rhythm-control strategy offered no survival advantage over a rate-control strategy in an intention-to-treat analysis. This article reports an "on-treatment" analysis of the relationship of survival to cardiac rhythm and treatment as they changed over time. Methods and Results--Modeling techniques were used to determine the relationships among survival, baseline clinical variables, and time-dependent variables. The following baseline variables were significantly associated with an increased risk of death: increasing age, coronary artery disease, congestive heart failure, diabetes, stroke or transient ischemic attack, smoking, left ventricular dysfunction, and mitral regurgitation. Among the time-dependent variables, the presence of sinus rhythm (SR) was associated with a lower risk of death, as was warfarin use. Antiarrhythmic drugs (AADs) were associated with increased mortality only after adjustment for the presence of SR. Consistent with the original intention-to-treat analysis, AADs were no longer associated with mortality when SR was removed from the model. Conclusions--Warfarin use improves survival. SR is either an important determinant of survival or a marker for other factors associated with survival that were not recorded, determined, or included in the survival model. Currently available AADs are not associated with improved survival, which suggests that any beneficial antiarrhythmic effects of AADs are offset by their adverse effects. If an effective method for maintaining SR with fewer adverse effects were available, it might be beneficial.
Revised on December 17, 2003
Accepted on December 23, 2003
Relationships Between Sinus Rhythm, Treatment, and Survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study
The AFFIRM Investigators
Key words: antiarrhythmia agents • anticoagulants • arrhythmia • fibrillation
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B. J. Padanilam and E. N. Prystowsky Should Ablation Be First-Line Therapy and for Whom: The Antagonist Position Circulation, August 23, 2005; 112(8): 1223 - 1231. [Full Text] [PDF]
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M. E. Goldman and L. B. Croft Atrial Fibrillation: The Ancient Conundrum Defies Simple Solution J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1813 - 1814. [Full Text] [PDF]
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 O. M. Wazni, N. F. Marrouche, D. O. Martin, A. Verma, M. Bhargava, W. Saliba, D. Bash, R. Schweikert, J. Brachmann, J. Gunther, et al. Radiofrequency Ablation vs Antiarrhythmic Drugs as First-line Treatment of Symptomatic Atrial Fibrillation: A Randomized Trial JAMA, June 1, 2005; 293(21): 2634 - 2640. [Abstract] [Full Text] [PDF]
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S. J. Hazel, H. S. Paterson, J. R.M. Edwards, and G. J. Maddern Surgical Treatment of Atrial Fibrillation via Energy Ablation Circulation, March 1, 2005; 111(8): e103 - e106. [Full Text] [PDF]
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K. Kikuchi, A. D. McDonald, T. Sasano, and J. K. Donahue Targeted Modification of Atrial Electrophysiology by Homogeneous Transmural Atrial Gene Transfer Circulation, January 25, 2005; 111(3): 264 - 270. [Abstract] [Full Text] [PDF]
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X. Liu, F. Ouyang, H. Mavrakis, C. Ma, J. Dong, S. Ernst, D. Bänsch, M. Antz, and K.-H. Kuck Complete pulmonary vein isolation guided by three-dimensional electroanatomical mapping for the treatment of paroxysmal atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy Europace, January 1, 2005; 7(5): 421 - 427. [Abstract] [Full Text] [PDF]
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L.-F. Hsu, P. Jais, P. Sanders, S. Garrigue, M. Hocini, F. Sacher, Y. Takahashi, M. Rotter, J.-L. Pasquie, C. Scavee, et al. Catheter Ablation for Atrial Fibrillation in Congestive Heart Failure N. Engl. J. Med., December 2, 2004; 351(23): 2373 - 2383. [Abstract] [Full Text] [PDF]
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W. G. Stevenson and L. W. Stevenson Atrial Fibrillation and Heart Failure -- Five More Years N. Engl. J. Med., December 2, 2004; 351(23): 2437 - 2440. [Full Text] [PDF]
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P. Zimetbaum and M. E. Josephson Is There a Role for Maintaining Sinus Rhythm in Patients with Atrial Fibrillation? Ann Intern Med, November 2, 2004; 141(9): 720 - 726. [Abstract] [Full Text] [PDF]
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T. D. Bahnson and A. O. Grant To Be or Not To Be in Normal Sinus Rhythm: What Do We Really Know? Ann Intern Med, November 2, 2004; 141(9): 727 - 729. [Full Text] [PDF]
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