Article Text

PDF
Heart rhythm disorders and pacemakers
The prognosis of patients with atrial fibrillation is improved when sinus rhythm is restored: report from the Stockholm Cohort of Atrial Fibrillation (SCAF)
  1. L Friberg1,
  2. N Hammar2,3,
  3. N Edvardsson4,
  4. M Rosenqvist5
  1. 1
    Karolinska Institute at South Hospital, Stockholm, Sweden
  2. 2
    Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
  3. 3
    AstraZeneca R&D, Mölndal, Sweden
  4. 4
    Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
  5. 5
    Department of Cardiology, South Hospital, Karolinska Institute, Stockholm, Sweden
  1. Dr L Friberg, GlobenHeart Clinic, Arenavägen 33, Box 100 01, S-121 26 Stockholm, Sweden; leif.friberg{at}stockholm.bonet.se

Abstract

Background: Clinical trials have indicated that an active rhythm control strategy aiming at restoration of sinus rhythm in patients with atrial fibrillation (AF) is no better than a rate-control strategy in terms of mortality and morbidity. To what extent restoration and maintenance of sinus rhythm per se affect long-term prognosis in AF patients is less clear.

Aim: To investigate if there are differences in mortality and morbidity between direct current (DC)-cardioverted AF patients who remain in sinus rhythm after cardioversion and those who relapse early.

Method: 361 cardioverted patients from the Stockholm Cohort Study on Atrial Fibrillation were studied by means of medical records and national registers. Patients were followed for a mean of 4.2 years from DC cardioversion regarding all-cause mortality and for a mean of 3.2 years for a composite endpoint of death, ischaemic stroke, myocardial infarction or hospitalisation for heart failure.

Results: All-cause mortality tended to be lower in patients who had been successfully cardioverted and had had no known relapse of AF within the first 3 months after cardioversion (hazard ratio (HR) 0.57, 95% CI 0.30 to 1.06, p = 0.076). They also had a significantly lower incidence of the composite endpoint than those who relapsed early (HR 0.51, 95% CI 0.32 to 0.82, p = 0.0058).

Conclusion: Restoration and 3 months maintenance of sinus rhythm was associated with improved long-term prognosis. The results imply that an active DC cardioversion approach is justified.

Statistics from Altmetric.com

Footnotes

  • Funding: This study was supported by unrestricted grants from the Stockholm County Council and AstraZeneca R&D, Mölndal, Sweden.

  • Competing interests: NH and NE are part-time employees of AstraZeneca R&D, Mölndal, Sweden. MR has been lecturing and acted as a national coordinator in clinical trials sponsored by Astra Zeneca. He is also a member of the Boehringer Ingelheim Swedish advisory committee regarding haemostasis.

  • Ethics approval: Ethics approval was provided by the Regional Ethics Committee of Stockholm.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.