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Ablation trumps meds for atrial fibrillation treatment. Catheter ablation provides better long-term relief from atrial fibrillation than medication, but surgical ablation is best, a second study concludes.

https://arctichealth.org/en/permalink/ahliterature122994
Source
Duke Med Health News. 2012 Mar;18(3):1-2
Publication Type
Article
Date
Mar-2012

Absence of protective effect of renin-angiotensin system inhibitors on atrial fibrillation development: insights from the Canadian Trial of Atrial Fibrillation (CTAF).

https://arctichealth.org/en/permalink/ahliterature155217
Source
Can J Cardiol. 2008 Sep;24(9):709-13
Publication Type
Article
Date
Sep-2008
Author
Maryse Palardy
Anique Ducharme
Stanley Nattel
Jean-Claude Tardif
Michel White
Normand Racine
Karine Tétreault
Farida Dabouz
Mario Talajic
Denis Roy
Author Affiliation
Department of Medicine, Montreal Heart Institute, Montreal, Canada.
Source
Can J Cardiol. 2008 Sep;24(9):709-13
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Aged
Amiodarone - therapeutic use
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy
Canada
Female
Humans
Male
Middle Aged
Multivariate Analysis
Propafenone - therapeutic use
Prospective Studies
Recurrence - prevention & control
Renin - antagonists & inhibitors
Renin-Angiotensin System - drug effects
Sotalol - therapeutic use
Abstract
Antiarrhythmic agents have modest efficacy in preventing atrial fibrillation (AF) recurrence. Although retrospective analyses have suggested a preventive effect of inhibitors of the renin-angiotensin system (RAS) on AF development in patients with congestive heart failure or hypertension, the value of these agents has not been evaluated in patients with AF but without a high prevalence of hypertension or heart failure.
A retrospective analysis of the Canadian Trial of Atrial Fibrillation (CTAF) was conducted. CTAF demonstrated the superiority of amiodarone (A) over sotalol or propafenone (SP) in maintaining sinus rhythm in patients with AF. Of the 403 patients randomly assigned in CTAF, 11.7% of the A group and 12.7% of the SP group were receiving a RAS inhibitor at baseline. By multivariate analysis (including all the risk factors known to be associated with AF available in the database), the use of RAS blockers in addition to antiarrhythmic agents was not associated with additional benefit against AF development. There was a recurrence of AF in 59 patients (38.3%) and 14 patients (29.8%) of groups A and A-RAS, respectively, while 93 patients (61.6%) and 32 patients (62.8%) of the SP and SP-RAS groups, respectively, experienced recurrent AF.
Blocking the RAS did not provide additional benefit against AF recurrence in CTAF patients treated with an antiarrhythmic drug. These results underscore the need for randomized clinical trials to clearly define the role of RAS inhibitors in treating AF.
Notes
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PubMed ID
18787722 View in PubMed
Less detail

Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.

https://arctichealth.org/en/permalink/ahliterature17828
Source
Circulation. 2004 Apr 27;109(16):1973-80
Publication Type
Article
Date
Apr-27-2004
Author
Jonathan S Steinberg
Ara Sadaniantz
Jack Kron
Andrew Krahn
D Marty Denny
James Daubert
W Barton Campbell
Edward Havranek
Katherine Murray
Brian Olshansky
Gearoid O'Neill
Magdi Sami
Stanley Schmidt
Randle Storm
Miguel Zabalgoitia
John Miller
Mary Chandler
Elaine M Nasco
H Leon Greene
Author Affiliation
Division of Cardiology, St Luke's-Roosevelt Hospital Center and Columbia University, New York, NY 10025, USA. jss7@columbia.edu
Source
Circulation. 2004 Apr 27;109(16):1973-80
Date
Apr-27-2004
Language
English
Publication Type
Article
Keywords
Aged
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy - mortality
Follow-Up Studies
Humans
Proportional Hazards Models
Research Support, U.S. Gov't, P.H.S.
Survival Analysis
Abstract
BACKGROUND: Expectations that reestablishing and maintaining sinus rhythm in patients with atrial fibrillation might improve survival were disproved in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. This report describes the cause-specific modes of death in the AFFIRM treatment groups. METHODS AND RESULTS: All deaths in patients enrolled in AFFIRM underwent blinded review by the AFFIRM Events Committee, and a mode of death was assigned. In AFFIRM, 2033 patients were randomized to a rhythm-control strategy and 2027 patients to a rate-control strategy. During a mean follow-up of 3.5 years, there were 356 deaths in the rhythm-control patients and 310 deaths in the rate-control patients (P=0.07). In the rhythm-control group, 129 patients (9%) died of a cardiac cause, and in the rate-control group, 130 patients (10%) died (P=0.95). Both groups had similar rates of arrhythmic and nonarrhythmic cardiac deaths. The numbers of vascular deaths were similar in the 2 groups: 35 (3%) in the rhythm-control group and 37 (3%) in the rate-control group (P=0.82). There were no differences in the rates of ischemic stroke and central nervous system hemorrhage. In the rhythm-control group, there were 169 noncardiovascular deaths (47.5% of the total number of deaths), whereas in the rate-control arm, there were 113 noncardiovascular deaths (36.5% of the total number of deaths) (P=0.0008). Differences in noncardiovascular death rates were due to pulmonary and cancer-related deaths. CONCLUSIONS: Management of atrial fibrillation with a rhythm-control strategy conferred no advantage over a rate-control strategy in cardiac or vascular mortality and may be associated with an increased noncardiovascular death rate.
Notes
Comment In: Circulation. 2004 Sep 14;110(11):e307-8; author reply e307-815364827
PubMed ID
15051639 View in PubMed
Less detail

An international view of how recent-onset atrial fibrillation is treated in the emergency department.

https://arctichealth.org/en/permalink/ahliterature118794
Source
Acad Emerg Med. 2012 Nov;19(11):1255-60
Publication Type
Article
Date
Nov-2012
Author
Carly Rogenstein
Anne-Maree Kelly
Suzanne Mason
Sandra Schneider
Eddy Lang
Catherine M Clement
Ian G Stiell
Author Affiliation
Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Source
Acad Emerg Med. 2012 Nov;19(11):1255-60
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Adult
Anti-Arrhythmia Agents - therapeutic use
Anticoagulants - therapeutic use
Atrial Fibrillation - diagnosis - therapy
Australasia
Canada
Chi-Square Distribution
Conscious Sedation - methods
Electric Countershock - utilization
Emergency Medicine - standards - trends
Emergency Service, Hospital
Female
Great Britain
Health Care Surveys
Heart rate
Humans
International Cooperation
Male
Middle Aged
Physician's Practice Patterns - trends
Questionnaires
Survival Rate
Treatment Outcome
United States
Abstract
This study was conducted to determine if there is practice variation for emergency physicians' (EPs) management of recent-onset atrial fibrillation (RAF) in various world regions (Canada, United States, United Kingdom, and Australasia).
The authors completed a mail and e-mail survey of members from four national emergency medicine (EM) associations. One prenotification letter and three survey letters were sent to members of the Canadian Association of Emergency Physicians (CAEP; Canada-1,177 members surveyed), American College of Emergency Physicians (ACEP; United States-500), College of Emergency Medicine UK (CEM; United Kingdom-1,864), and Australasian College for Emergency Medicine (ACEM; Australasia-1,188) as per the modified Dillman technique. The survey contained 23 questions related to the management of adult patients with symptomatic RAF (either a first episode or paroxysmal-recurrent) where onset is less than 48 hours and cardioversion is considered a treatment option. Data were analyzed using descriptive and chi-square statistics.
Response rates were as follows: overall, 40.5%; Canada, 43.0%; United States, 50.1%; United Kingdom, 38.1%; and Australasia, 38.0%. Physician demographics were as follows: 72% male and mean (?SD) age 41.7 (?8.39) years. The proportions of physicians attempting rate control as their initial strategy are United States, 94.0%; Canada, 70.7%; Australasia, 61.1%; and United Kingdom, 43.1% (p
PubMed ID
23167856 View in PubMed
Less detail

The anti-arrhythmia properties of the functional opioid agonist orphanin FQ (nociceptin)]

https://arctichealth.org/en/permalink/ahliterature10569
Source
Eksp Klin Farmakol. 1999 Sep-Oct;62(5):21-4
Publication Type
Article
Author
L N Maslov
A V Krylatov
Iu B Lishmanov
E. Albrecht
Author Affiliation
Department of Experimental Cardiology, Institute of Cardiology, Siberian Branch, Russian Academy of Medical Sciences, Tomsk, Russia.
Source
Eksp Klin Farmakol. 1999 Sep-Oct;62(5):21-4
Language
Russian
Publication Type
Article
Keywords
Aconitine
Animals
Anti-Arrhythmia Agents - therapeutic use
Arrhythmia - chemically induced - drug therapy - physiopathology
Calcium Chloride
Disease Models, Animal
Drug Evaluation, Preclinical
Electrocardiography - drug effects
English Abstract
Epinephrine
Male
Opioid Peptides - therapeutic use
Rats
Rats, Wistar
Receptors, Opioid - agonists
Research Support, Non-U.S. Gov't
Time Factors
Abstract
It was shown that the agonist of peripheral ORL1 receptors nociceptine raises heart resistance to the antiarrhythmic effect of aconitine. The antiarrhythmic effect of nociceptine is not connected with a change in the tonus of the autonomous nervous system or with an effect on opiate receptors. It is assumed that the antiarrhythmic properties of nociceptine are realized through inhibition of Na+/Ca2+ metabolism or blockade of rapid Na(+) channels of the cardiomyocytes.
PubMed ID
10572746 View in PubMed
Less detail

Antiarrhythmic activity of n-tyrosol during acute myocardial ischemia and reperfusion.

https://arctichealth.org/en/permalink/ahliterature87784
Source
Bull Exp Biol Med. 2007 Jun;143(6):689-91
Publication Type
Article
Date
Jun-2007
Author
Chernyshova G A
Plotnikov M B
Smol'yakova V I
Golubeva I V
Aliev O I
Tolstikova T G
Krysin A P
Sorokina I V
Author Affiliation
Department of Circulation Pharmacology, State Research Institute of Pharmacology, Tomsk Research Center, Siberian Division of the Russian Academy of Medical Sciences.
Source
Bull Exp Biol Med. 2007 Jun;143(6):689-91
Date
Jun-2007
Language
English
Russian
Publication Type
Article
Keywords
Animals
Anti-Arrhythmia Agents - therapeutic use
Myocardial Reperfusion Injury - drug therapy
Phenylethyl Alcohol - analogs & derivatives - therapeutic use
Rats
Rats, Wistar
Tachycardia, Ventricular - prevention & control
Ventricular Fibrillation - prevention & control
Abstract
Antiarrhythmic activity of n-tyrosol was demonstrated on the model of early occlusion and reperfusion arrhythmia. The preparation reduces the incidence of ventricular tachycardia and fibrillation, increases the percent of animals without ventricular arrhythmia, and moderates the severity of developing ventricular arrhythmias.
PubMed ID
18239802 View in PubMed
Less detail

Antiarrhythmic therapy and risk of death in patients with atrial fibrillation: a nationwide study.

https://arctichealth.org/en/permalink/ahliterature150959
Source
Europace. 2009 Jul;11(7):886-91
Publication Type
Article
Date
Jul-2009
Author
Søren Skøtt Andersen
Morten Lock Hansen
Gunnar H Gislason
Tina Ken Schramm
Fredrik Folke
Emil Fosbøl
Steen Z Abildstrøm
Mette Madsen
Lars Køber
Christian Torp-Pedersen
Author Affiliation
Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, Hellerup, Copenhagen DK-2900, Denmark. ssa@heart.dk
Source
Europace. 2009 Jul;11(7):886-91
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Aged
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy - mortality
Cohort Studies
Denmark - epidemiology
Female
Humans
Incidence
Male
Middle Aged
Proportional Hazards Models
Registries
Risk assessment
Risk factors
Survival Analysis
Survival Rate
Treatment Outcome
Abstract
To examine the risk of death associated with antiarrhythmic drug (AAD) therapy in a nationwide unselected cohort of patients with atrial fibrillation (AF).
All patients admitted with AF in Denmark from 1995 to 2004 and their subsequent use of AADs were identified by individual-level linkage of nationwide registries. Multivariable Cox proportional-hazard models with time-dependent covariates were used to analyse the risk of death associated with AAD therapy. A total of 141,500 patients were included in the study; of these 3356 (2.4%) patients received treatment with flecainide, 3745 (2.6%) propafenone, 23,346 (16.5%) sotalol, and 10,376 (7.3%) amiodarone. Annualized mortality rates were 2.54, 4.25, 5.29, and 7.42 per year per 100 person years for flecainide, propafenone, sotalol, and amiodarone, respectively. Multivariable Cox proportional-hazard models did not show increased risk of death associated with any of the AADs. Hazard ratio (95% confidence interval) for flecainide 0.38 (0.32-0.44), propafenone 0.65 (0.58-0.71), sotalol 0.65 (0.63-0.67), and amiodarone 0.94 (0.89-1.00).
In an unselected cohort of patients with AF, antiarrhythmic treatment with flecainide, propafenone, sotalol, or amiodarone was not associated with increased risk of death. From a safety perspective, this indicates appropriate selection of patients for AAD therapy.
Notes
Comment In: Europace. 2009 Jul;11(7):840-119546183
Comment In: Europace. 2009 Jul;11(7):837-919546182
PubMed ID
19443433 View in PubMed
Less detail

Antiarrhythmic use from 1991 to 2007: insights from the Canadian Registry of Atrial Fibrillation (CARAF I and II).

https://arctichealth.org/en/permalink/ahliterature143905
Source
Heart Rhythm. 2010 Sep;7(9):1171-7
Publication Type
Article
Date
Sep-2010
Author
Jason G Andrade
Stuart J Connolly
Paul Dorian
Martin Green
Karin H Humphries
George J Klein
Robert Sheldon
Mario Talajic
Charles R Kerr
Author Affiliation
St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Source
Heart Rhythm. 2010 Sep;7(9):1171-7
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy - epidemiology - physiopathology
Calcium Channel Blockers - therapeutic use
Canada - epidemiology
Electrocardiography - drug effects
Follow-Up Studies
Heart Rate - drug effects
Humans
Middle Aged
Morbidity - trends
Prospective Studies
Registries
Retrospective Studies
Time Factors
Treatment Outcome
Abstract
The pharmacologic management of atrial fibrillation (AF), the most common sustained cardiac arrhythmia, has been traditionally dichotomized into control of ventricular rate or re-establishment and maintenance of sinus rhythm.
The purpose of this study was to evaluate the use of rate-controlling drugs and antiarrhythmic drugs (AAD) in the Canadian Registry of Atrial Fibrillation (CARAF) over a 16-year period from 1991 through 2007.
1,400 patients with new-onset paroxysmal AF who were enrolled in CARAF were included in this analysis. We assessed trends in ventricular rate-controlling medication use (digoxin, beta-blockers, and calcium channel blockers) and AAD (class IA, IC, and III antiarrhythmic agents) at baseline and follow-up visits as well as by calendar year.
AAD use increased initially from 1991 to 1994 (peak use 42.5%) before steadily declining. Sotalol use decreased (27% to 6%), whereas amiodarone use increased (1.6% to 17.9%). Rate-controlling medication use decreased from 1991 to 1995 (54.1% to 34.1%) due to declining digoxin use (62.9% to 16.3%). After 1999, there was a continued increase in rate-controlling medication use (peak use 52.5% in 2007) due to increased beta-blocker use (17% to 45.7%). Calcium channel blockers use changed little over the duration of the study.
The management of AF has undergone significant shifts since 1990, reflecting the influence of drug development, prevailing belief systems, the impact of large clinical trials, and evidence-based recommendations. Monitoring of pharmacotherapy trends will provide insight into the real-world application of evidence-based guidelines as well as allow the opportunity to identify deficiencies and improve patient care.
PubMed ID
20430112 View in PubMed
Less detail

Appropriate use of the implantable cardioverter defibrillator: a Canadian perspective. Canadian Working Group on Cardiac Pacing.

https://arctichealth.org/en/permalink/ahliterature203131
Source
Pacing Clin Electrophysiol. 1999 Jan;22(1 Pt 1):1-4
Publication Type
Article
Date
Jan-1999

112 records – page 1 of 12.