Impact of drug alteration to maintain rhythm control in paroxysmal atrial fibrillation. - Subanalysis from J-RHYTHM study -.
BACKGROUND
The Japanese Rhythm Management Trial for Atrial Fibrillation (J-RHYTHM) study showed rhythm control was associated with fewer changes in the assigned treatment strategy compared to rate control in atrial fibrillation (AF). The aim was to describe how antiarrhythmics (AAs) were altered in the rhythm control arm and whether altering AAs would impact long-term outcomes.


RESULTS
Of 390 enrolled patients, 23.5% altered their AAs (drug alteration [DA] group). The hard endpoint (HE) was defined as a composite of death, stroke, embolism, major bleeding or heart failure hospitalization; soft endpoint (SE) was defined physical/psychological disability requiring alteration of treatment strategy. The patients were followed for 1.7 years. No significant difference was noted in the occurrence of HE (4.0% vs 6.5%, P=0.31), but DA-group patients had higher rates of SE (9.3% vs 18.4%, P=0.017) compared to single AA patients. The DA group was also associated with the occurrence of SE after adjustment (HR 1.90, P=0.042). When the DA group was subdivided according to the use of class III drugs or change of drugs between classes, there were no differences in outcomes.


CONCLUSIONS
The need to change AA was associated with physical/psychological disabilities that seemed not to be relieved simply by changing AAs, and this should be considered as a marker for refractory paroxysmal AF requiring other strategies.
Endo
Ayaka
A
Keio University School of Medicine, Tokyo, Japan. ayakaendo@cpnet.med.keio.ac.jp
Kohsaka
Shun
S
Suzuki
Shinya
S
Atarashi
Hirotsugu
H
Kamakura
Shiro
S
Sakurai
Masayuki
M
Nakaya
Haruaki
H
Fukatani
Masahiko
M
Mitamura
Hideo
H
Yamazaki
Tsutomu
T
Yamashita
Takeshi
T
Ogawa
Satoshi
S
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000494:pharmacology*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality; D004617:Embolism / Q000139:chemically induced / Q000401:mortality; D023381:Endpoint Determination; D005260:Female; D006333:Heart Failure / Q000139:chemically induced / Q000401:mortality; D006339:Heart Rate / Q000187:drug effects*; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000139:chemically induced / Q000401:mortality
D000889:Anti-Arrhythmia Agents