TY - JOUR
T1 - Cardioversion strategy impacts rate control during recurrences in patients with paroxysmal atrial fibrillation
T2 - A subanalysis of the RACE 7 ACWAS trial
AU - van der Velden, Rachel M. J.
AU - Pluymaekers, Nikki A. H. A.
AU - Dudink, Elton A. M. P.
AU - Luermans, Justin G. L. M.
AU - Meeder, Joan G.
AU - Heesen, Wilfred F.
AU - Lenderink, Timo
AU - Widdershoven, Jos W. M. G.
AU - Bucx, Jeroen J. J.
AU - Rienstra, Michiel
AU - Kamp, Otto
AU - van Opstal, Jurren M.
AU - Kirchhof, Charles J. H. J.
AU - van Dijk, Vincent F.
AU - Swart, Henk P.
AU - Alings, Marco
AU - van Gelder, Isabelle C.
AU - Crijns, Harry J. G. M.
AU - Linz, Dominik
N1 - Funding Information: The present substudy was supported by a grant (104021005) from the Netherlands Organization for Health Research and Development. The RACE 7 ACWAS trial was supported by a grant (837002524) from the Netherlands Organization for Health Research and Development–Health Care Efficiency Research Program and by the Maastricht University Medical Center. Boehringer Ingelheim provided some of the remote monitoring devices. Funding Information: The present substudy was supported by a grant (104021005) from the Netherlands Organization for Health Research and Development. The RACE 7 ACWAS trial was supported by a grant (837002524) from the Netherlands Organization for Health Research and Development–Health Care Efficiency Research Program and by the Maastricht University Medical Center. Boehringer Ingelheim provided some of the remote monitoring devices. Publisher Copyright: © 2023 The Authors. Clinical Cardiology published by Wiley Periodicals, LLC.
PY - 2024/1
Y1 - 2024/1
N2 - Background: In the Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See, patients with recent-onset atrial fibrillation (AF) were randomized to either early or delayed cardioversion. Aim: This prespecified sub-analysis aimed to evaluate heart rate during AF recurrences after an emergency department (ED) visit identified by an electrocardiogram (ECG)-based handheld device. Methods: After the ED visit, included patients (n = 437) were asked to use an ECG-based handheld device to monitor for recurrences during the 4-week follow-up period. 335 patients used the handheld device and were included in this analysis. Recordings from the device were collected and assessed for heart rhythm and rate. Optimal rate control was defined as a target resting heart rate of <110 beats per minute (bpm). Results: In 99 patients (29.6%, mean age 67 ± 10 years, 39.4% female, median 6 [3–12] AF recordings) a total of 314 AF recurrences (median 2 [1–3] per patient) were identified during follow-up. The average median resting heart rate at recurrence was 100 ± 21 bpm in the delayed vs 112 ± 25 bpm in the early cardioversion group (p =.011). Optimal rate control was seen in 68.4% [21.3%–100%] and 33.3% [0%–77.5%] of recordings (p =.01), respectively. Randomization group [coefficient −12.09 (−20.55 to −3.63, p =.006) for delayed vs. early cardioversion] and heart rate on index ECG [coefficient 0.46 (0.29–0.63, p <.001) per bpm increase] were identified on multivariable analysis as factors associated with lower median heart rate during AF recurrences. Conclusion: A delayed cardioversion strategy translated into a favorable heart rate profile during AF recurrences.
AB - Background: In the Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See, patients with recent-onset atrial fibrillation (AF) were randomized to either early or delayed cardioversion. Aim: This prespecified sub-analysis aimed to evaluate heart rate during AF recurrences after an emergency department (ED) visit identified by an electrocardiogram (ECG)-based handheld device. Methods: After the ED visit, included patients (n = 437) were asked to use an ECG-based handheld device to monitor for recurrences during the 4-week follow-up period. 335 patients used the handheld device and were included in this analysis. Recordings from the device were collected and assessed for heart rhythm and rate. Optimal rate control was defined as a target resting heart rate of <110 beats per minute (bpm). Results: In 99 patients (29.6%, mean age 67 ± 10 years, 39.4% female, median 6 [3–12] AF recordings) a total of 314 AF recurrences (median 2 [1–3] per patient) were identified during follow-up. The average median resting heart rate at recurrence was 100 ± 21 bpm in the delayed vs 112 ± 25 bpm in the early cardioversion group (p =.011). Optimal rate control was seen in 68.4% [21.3%–100%] and 33.3% [0%–77.5%] of recordings (p =.01), respectively. Randomization group [coefficient −12.09 (−20.55 to −3.63, p =.006) for delayed vs. early cardioversion] and heart rate on index ECG [coefficient 0.46 (0.29–0.63, p <.001) per bpm increase] were identified on multivariable analysis as factors associated with lower median heart rate during AF recurrences. Conclusion: A delayed cardioversion strategy translated into a favorable heart rate profile during AF recurrences.
KW - acute management
KW - atrial fibrillation
KW - cardioversion
KW - mobile health
KW - rate control
UR - http://www.scopus.com/inward/record.url?scp=85174617364&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/clc.24161
DO - https://doi.org/10.1002/clc.24161
M3 - Article
C2 - 37872853
SN - 0160-9289
VL - 47
JO - Clinical cardiology
JF - Clinical cardiology
IS - 1
M1 - e24161
ER -