title: Aggressive approach and outcome in patients presenting atrial fibrillation and hypertension.
abstract: OBJECTIVE
  Aggressive approach in patients presenting atrial fibrillation (AF) and hypertension could result in improving rhythm control and reducing admission.
  
  
  METHODS
  Out of 3475 patients presenting AF, those with hypertension (n=1739, 52%) underwent standard (n=591, group 1, years 2004-2005) or aggressive pharmacological and electrical approach (n=1148, group 2, years 2006-2009). Overall, in 1071 patients AF duration was less than 48 h. Primary endpoint was rhythm conversion; secondary endpoints were modalities of rhythm conversion and reduction of admissions.
  
  
  RESULTS
  At univariate and multivariate analyses, AF lasting less than 48 h, absence of comorbidities and younger age were independent predictors of sinus rhythm; conversely, lack of sinus rhythm, older age, AF lasting more than 48 h and comorbidities were independent predictors of hospitalization. Overall, 55% of patients achieved sinus rhythm in group 1 versus 62% in group 2 (p=0.018). Interestingly, in patients with AF lasting less than 48 h, 89% achieved sinus rhythm, more likely by class 1C than by class III antiarrhythmic drugs (p<0.001). Overall reduction of admission accounts for 60%; 50% of patients need admission in group 1 versus 29% in group 2 (p<0.001).
  
  
  CONCLUSIONS
  Aggressive pharmacological and electrical approach in patients presenting AF and hypertension significantly improved rhythm conversion overall up to 62%. Patients with AF lasting less than 48 h eventually achieved sinus rhythm up to 89%, mostly by class IC antiarrhythmic drugs. Admissions eventually reduced up to 60%.
authors: Emergency Medicine, Department of Medical and Surgical Critical Care, University of Florence and Careggi University Hospital, Florence, Italy. aaaconti@hotmail.com
authors: Alberto
authors: A
authors: Conti
authors: Erica
authors: E
authors: Canuti
authors: Yuri
authors: Y
authors: Mariannini
authors: Maurizio
authors: M
authors: Zanobetti
authors: Francesca
authors: F
authors: Innocenti
authors: Barbara
authors: B
authors: Paladini
authors: Giuseppe
authors: G
authors: Pepe
authors: Luigi
authors: L
authors: Padeletti
authors: Gian Franco
authors: GF
authors: Gensini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D004554:Electric Countershock / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents