Sinus rhythm restoration and treatment success: insight from recent clinical trials.
Atrial fibrillation (AF) is a common supraventricular tachyarrhythmia with substantial morbidity and mortality. This review briefly describes the mechanisms of AF development and progression, including electrical, structural, and contractile remodeling. In addition, the potential benefits of achieving and maintaining sinus rhythm are discussed. For example, rhythm control has been associated with improvements in left ventricular function, AF symptoms, exercise tolerance, the ability to perform activities of daily living, and quality of life. More recently, dronedarone, a noniodinated benzofuran derivative approved for use in the treatment of AF, was shown to significantly improve clinical outcomes including cardiovascular hospitalizations and death from any cause in A Placebo-Controlled, Double-Blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg bid for the Prevention of Cardiovascular Hospitalization or Death From Any Cause in Patients With Atrial Fibrillation/Atrial Flutter (ATHENA). The review concludes with an examination of AF treatment options and expectations. Evidence suggests that the complete absence of AF recurrence is not always achievable; however, complete restoration of sinus rhythm may not be necessary for patients to achieve clinically meaningful benefits. Copyright © 2011 Wiley Periodicals, Inc. The editorial assistance provided for this manuscript was funded by Sanofi-Aventis. The authors were fully responsible for all content and editorial decision, and received no financial support or other form of compensation related to the development of the paper. The authors have no other funding, financial relationships, or conflicts of interest to disclose.
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA. salibaw@ccf.org
Walid
W
Saliba
Oussama M
OM
Wazni
D000368:Aged; D000638:Amiodarone / Q000031:analogs & derivatives / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation; D002986:Clinical Trials as Topic; D000077764:Dronedarone; D004554:Electric Countershock; D019317:Evidence-Based Medicine; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D012008:Recurrence; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D000077764:Dronedarone; D000638:Amiodarone
Med Clin North Am. 2008 Jan;92(1):237-58, xiii
18061007
Expert Rev Cardiovasc Ther. 2007 Jul;5(4):673-9
17605646
Circulation. 2004 Jan 27;109(3):363-8
14732752
Circulation. 2004 Apr 27;109(16):1973-80
15051639
J Am Coll Cardiol. 2003 May 21;41(10):1690-6
12767648
Eur Heart J. 2006 Aug;27(16):1979-2030
16885201
Circulation. 2001 Jul 17;104(3):292-6
11457747
N Engl J Med. 2002 Dec 5;347(23):1825-33
12466506
Cardiovasc Drug Rev. 2005 Fall;23(3):217-30
16252015
Virchows Arch. 2004 Nov;445(5):498-505
15221371
Circulation. 2001 Feb 6;103(5):684-90
11156880
Am J Cardiol. 2003 Mar 20;91(6A):15D-26D
12670638
Am Heart J. 2008 Sep;156(3):527.e1-9
18760136
Circulation. 2009 Sep 29;120(13):1174-80
19752319
N Engl J Med. 2004 Dec 2;351(23):2384-91
15575054
Circulation. 2000 Mar 14;101(10):1138-44
10715260
Heart. 2004 Apr;90(4):400-5
15020515
Pacing Clin Electrophysiol. 2005 Jan;28 Suppl 1:S86-9
15683535
N Engl J Med. 2008 Jun 19;358(25):2678-87
18565860
Drugs. 2005;65(12):1651-67
16060699
Prog Cardiovasc Dis. 2005 Nov-Dec;48(3):153-68
16271942
Circulation. 1996 Oct 1;94(7):1585-91
8840848
Eur Heart J. 2002 Jun;23(11):892-900
12042011
J Interv Card Electrophysiol. 2005 Sep;13(3):181-93
16177845
J Cardiovasc Electrophysiol. 2007 Jan;18(1):9-14
17081210
Circulation. 2004 Mar 30;109(12):1509-13
15007003
J Cardiovasc Pharmacol Ther. 2005 Jun;10(2):81-3
15965558
Circ Arrhythm Electrophysiol. 2009 Aug;2(4):349-61
19808490
N Engl J Med. 2007 Sep 6;357(10):987-99
17804843
Europace. 2007 Jun;9(6):335-79
17599941
Arch Intern Med. 2006 Apr 10;166(7):719-28
16606807
J Am Coll Cardiol. 2004 Jan 21;43(2):241-7
14736444
Lancet. 2000 Nov 25;356(9244):1789-94
11117910
Am Heart J. 2002 Jun;143(6):984-90
12075253
Circulation. 1998 Dec 8;98(23):2574-9
9843465
Circ Arrhythm Electrophysiol. 2009 Dec;2(6):626-33
20009077
J Cardiovasc Pharmacol Ther. 2004 Jun;9(2):65-73
15309242
Eur Heart J. 2003 Aug;24(16):1481-7
12919771
Int J Cardiol. 2006 Jun 28;110(3):301-12
16516313
Chest. 2004 Aug;126(2):476-86
15302734
N Engl J Med. 2001 Apr 5;344(14):1067-78
11287978
Nature. 2002 Jan 10;415(6868):219-26
11805846
Heart Rhythm. 2005 Jan;2(1):19-24
15851259
N Engl J Med. 2009 Feb 12;360(7):668-78
19213680
Am Heart J. 2009 Jul;158(1):15-20
19540387
Prog Cardiovasc Dis. 2005 Sep-Oct;48(2):125-38
16253652
N Engl J Med. 2002 Dec 5;347(23):1834-40
12466507
Circulation. 2004 Jun 15;109(23):2839-43
15197156
Am Heart J. 1964 Feb;67:200-20
14118488
N Engl J Med. 2005 May 5;352(18):1861-72
15872201
J Am Coll Cardiol. 2004 Mar 3;43(5):818-25
14998623
Cardiovasc Res. 2002 Jan;53(1):192-201
11744028
N Engl J Med. 2004 Dec 2;351(23):2373-83
15575053
Cardiovasc Res. 2002 May;54(2):315-24
12062337
Stroke. 1991 Aug;22(8):983-8
1866765
Cardiol Clin. 2004 Feb;22(1):101-11
14994851
Europace. 2006 Nov;8(11):943-9
16973685
J Am Coll Cardiol. 2003 Jul 2;42(1):20-9
12849654
Circulation. 2005 Mar 8;111(9):1100-5
15723973
Am Heart J. 2005 Apr;149(4):645-9
15990747
N Engl J Med. 1998 Sep 3;339(10):659-66
9725923
Cardiovasc Res. 2000 Aug;47(2):244-53
10946061
Cardiol Clin. 2004 Feb;22(1):9-20
14994844
Cardiovasc Res. 2002 May;54(2):230-46
12062329
J Am Coll Cardiol. 2006 Aug 15;48(4):721-30
16904540
Pacing Clin Electrophysiol. 2003 Mar;26(3):678-84
12698667