Real-Life Observations of Clinical Outcomes With Rhythm- and Rate-Control Therapies for Atrial Fibrillation: RECORDAF (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation)

doi:10.1016/j.jacc.2011.03.034

Journal of the American College of Cardiology

Volume 58, Issue 5, 26 July 2011, Pages 493-501

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Objectives

RECORDAF is the first worldwide, prospective, observational survey of management of atrial fibrillation (AF) in unselected, community-based patients.

Background

Primary outcomes were therapeutic success and clinical outcomes associated with rhythm-control and rate-control strategies.

Methods

Patients with recent-onset AF were included (n = 5,604). Treatment strategy (rhythm control or rate control) was noted at baseline. Follow-up was 12 months. Therapeutic success required that strategy was unchanged without clinical events. Further maintenance of sinus rhythm was required in the rhythm-control group, and heart rate ≤80 beats/min in the rate-control group.

Results

Data from 5,171 patients were assessable. Therapeutic success was 54% overall (rhythm control 60% vs. rate control 47%), a result driven by control of AF: rhythm control, 81% vs. rate control, 74%. After adjustment for propensity score quintiles, the rhythm-control strategy was significantly related to superior therapeutic success (odds ratio: 1.34, 95% confidence interval: 1.15 to 1.55; p = 0.0002). Clinical events occurred in 18% of patients. The arrhythmia management strategy was not predictive of clinical events. The type (persistent), presence at baseline visit, and duration (>3 months) of AF, together with age older than 75 years and the presence of heart failure, predicted progression to permanent AF. The choice of rhythm control reduced the likelihood of AF progression (odds ratio: 0.20, 95% confidence interval: 0.17 to 0.25; p < 0.0001).

Conclusions

Clinical outcomes in AF patients were driven mainly by hospitalizations for arrhythmia/proarrhythmia and other cardiovascular causes, but not by the choice of rate or rhythm strategy. Rhythm-control patients progressed less rapidly to permanent AF.

Key Words

atrial fibrillation

rate control

rhythm control

Abbreviations and Acronyms

atrial fibrillation

CAD

coronary artery disease

confidence interval

ECG

electrocardiogram

myocardial infarction

odds ratio

TIA

transient ischemic attack

Cited by (0)

: The registry has been funded by sanofi-aventis. Editorial support for final manuscript formatting and final editing was funded by sanofi-aventis. Dr. Camm is a consultant and lecturer for sanofi-aventis. Dr. Breithardt has served on advisory boards for Bayer Healthcare, Boehringer Ingelheim, MSD (Merck & Co.), and sanofi-aventis. Dr. Crijns has served on advisory boards for sanofi-aventis, AstraZeneca, and MEDACorp. Dr. Dorian is a consultant to and has received research support from sanofi-aventis and Boehringer Ingelheim. Dr. Kowey is a consultant to and speaker for sanofi-aventis. Dr. Le Heuzey is a consultant to and served on advisory boards for sanofi-aventis, Bristol-Myers Squibb, MEDACorp, Boehringer Ingelheim, MSD (Merck & Co.), Bayer Healthcare, Pfizer Inc., Servier, Daiichi-Sankyo, and Medtronic. Drs. Merioua and Pedrazzini are employees of sanofi-aventis. Dr. Prystowsky is a consultant to sanofi-aventis, Boehringer Ingelheim, Bard, Medtronic, Stereotaxis, and CardioNet and owns stock in and is a director of Stereotaxis and CardioNet. Dr. Schwartz is a consultant to sanofi-aventis. Dr. Torp-Pedersen has received research grants from sanofi-aventis and Cardiome and is a consultant to Cardiome, sanofi-aventis, and Merck & Co. Dr. Weintraub has received research grants from and has consulted and served on advisory boards for sanofi-aventis. C. Noel Bairey-Marz, MD, served as Guest Editor for this paper.