Physician stated atrial fibrillation management in light of treatment guidelines: data from an international, observational prospective survey.
BACKGROUND
The Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation (RecordAF) study is the first worldwide, prospective, survey of real-life management of atrial fibrillation (AF) in recently diagnosed patients (n = 5604) with a 1-year follow-up.


OBJECTIVE
Surveys of AF management have identified a divergence between guidelines and clinical practice, and an overinterpretation of guidelines in low-risk patients.


METHODS
: Physicians' theoretical approaches to rhythm and rate control were investigated using a pre-study questionnaire.


RESULTS
One cardiologist, from each of the 583 sites in 6 regions, completed a questionnaire on their practice and management of AF patients. In AF patients with structural heart disease (SHD), amiodarone was the most frequent choice of first-line rhythm control agents in all regions. Amiodarone or sotalol tended to be the preferred second-line rhythm control agents, 1 exception being Central/South America. beta-Blockers were the first-line rate control agents for patients with AF and SHD in all regions, and calcium channel blockers and cardiac glycosides were the most common second-line rate control treatments in all regions, except Asia. In lone AF patients, propafenone (30.6%), flecainide (24.1%), and amiodarone (21.7%) were the most common global choices of first-line rhythm control, and amiodarone or sotalol were the preferred second-line rhythm control agents, 1 exception being Central/South America.


CONCLUSIONS
These results highlight points of divergence from the American College of Cardiology (ACC)/ American Heart Association (AHA)/European Society of Cardiology (ESC) guidelines for the management of AF in terms of first-line drug selection in patients with associated SHD or coronary artery disease.
Lankenau Hospital, 100 Lancaster Avenue, Wynnewood, PA, USA. koweyp@mlhs.org
Peter R
PR
Kowey
Günter
G
Breithardt
John
J
Camm
Harry
H
Crijns
Paul
P
Dorian
Jean-Yves
JY
Le Heuzey
Laurence
L
Pedrazzini
Eric N
EN
Prystowsky
Geneviève
G
Salette
Peter J
PJ
Schwartz
Christian
C
Torp-Pedersen
William
W
Weintraub
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002301:Cardiac Glycosides / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002983:Clinical Competence; D005260:Female; D005424:Flecainide / Q000627:therapeutic use; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011405:Propafenone / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries; D013015:Sotalol / Q000627:therapeutic use; D011795:Surveys and Questionnaires
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers; D002301:Cardiac Glycosides; D002316:Cardiotonic Agents; D011405:Propafenone; D013015:Sotalol; D005424:Flecainide; D000638:Amiodarone