Comparison of rate versus rhythm control in patients with atrial fibrillation and a pacemaker

Apurva Omkar Badheka, George Robert Marzouka, Ankit Dineshbhai Rathod, Nileshkumar Jasmatbhai Patel, Robert J Myerburg, Raul Mitrani

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The effect of rate versus rhythm control in patients with atrial fibrillation who have undergone previous pacemaker (PM) implantation is unknown. We evaluated the mortality in patients with atrial fibrillation and a PM randomized to rate or rhythm control treatment strategies. The Atrial Fibrillation Follow-up Investigation of Rhythm Management data set was stratified by the presence (n = 250) or absence (n = 3,810) of a PM at randomization into the rate or rhythm control arm. Kaplan-Meier curves were used for univariate analysis, and proportional hazards were used for multivariate analysis. The subjects with a PM (n = 250) were older (73 vs 69 years, p <0.01) and had a greater prevalence of coronary artery disease (53% vs 37%, p <0.01) and congestive heart failure (33% vs 23%, p <0.01). All-cause mortality was significantly greater in the PM patients who were randomized to the rhythm control arm (n = 128) than in the patients enrolled in the rate control arm with or without a PM (n = 2,027, p <0.01) and those in the rhythm control arm without a PM (n = 1,905, p <0.01). Multivariate analysis revealed that predictors of all-cause mortality included PM patients randomized to the rhythm control arm (hazard ratio 2.59, 95% confidence interval 1.46 to 4.58, p <0.01) and the presence of congestive heart failure (hazard ratio 2.42, 95% confidence interval 1.40 to 4.16, p <0.01). In conclusion, all-cause mortality was greater among patients with atrial fibrillation with a PM, who were randomized to the rhythm control arm of the Atrial Fibrillation Follow-up Investigation of Rhythm Management study compared with all other patients enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management study. The rhythm control strategy in patients with a PM was an independent predictor of mortality.

Original languageEnglish
Pages (from-to)1759-1763
Number of pages5
JournalAmerican Journal of Cardiology
Volume111
Issue number12
DOIs
StatePublished - Jun 15 2013

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Atrial Fibrillation
Mortality
Multivariate Analysis
Heart Failure
Confidence Intervals
Safety Management
Random Allocation
Coronary Artery Disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of rate versus rhythm control in patients with atrial fibrillation and a pacemaker. / Badheka, Apurva Omkar; Marzouka, George Robert; Rathod, Ankit Dineshbhai; Patel, Nileshkumar Jasmatbhai; Myerburg, Robert J; Mitrani, Raul.

In: American Journal of Cardiology, Vol. 111, No. 12, 15.06.2013, p. 1759-1763.

Research output: Contribution to journalArticle

Badheka, Apurva Omkar ; Marzouka, George Robert ; Rathod, Ankit Dineshbhai ; Patel, Nileshkumar Jasmatbhai ; Myerburg, Robert J ; Mitrani, Raul. / Comparison of rate versus rhythm control in patients with atrial fibrillation and a pacemaker. In: American Journal of Cardiology. 2013 ; Vol. 111, No. 12. pp. 1759-1763.
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abstract = "The effect of rate versus rhythm control in patients with atrial fibrillation who have undergone previous pacemaker (PM) implantation is unknown. We evaluated the mortality in patients with atrial fibrillation and a PM randomized to rate or rhythm control treatment strategies. The Atrial Fibrillation Follow-up Investigation of Rhythm Management data set was stratified by the presence (n = 250) or absence (n = 3,810) of a PM at randomization into the rate or rhythm control arm. Kaplan-Meier curves were used for univariate analysis, and proportional hazards were used for multivariate analysis. The subjects with a PM (n = 250) were older (73 vs 69 years, p <0.01) and had a greater prevalence of coronary artery disease (53{\%} vs 37{\%}, p <0.01) and congestive heart failure (33{\%} vs 23{\%}, p <0.01). All-cause mortality was significantly greater in the PM patients who were randomized to the rhythm control arm (n = 128) than in the patients enrolled in the rate control arm with or without a PM (n = 2,027, p <0.01) and those in the rhythm control arm without a PM (n = 1,905, p <0.01). Multivariate analysis revealed that predictors of all-cause mortality included PM patients randomized to the rhythm control arm (hazard ratio 2.59, 95{\%} confidence interval 1.46 to 4.58, p <0.01) and the presence of congestive heart failure (hazard ratio 2.42, 95{\%} confidence interval 1.40 to 4.16, p <0.01). In conclusion, all-cause mortality was greater among patients with atrial fibrillation with a PM, who were randomized to the rhythm control arm of the Atrial Fibrillation Follow-up Investigation of Rhythm Management study compared with all other patients enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management study. The rhythm control strategy in patients with a PM was an independent predictor of mortality.",
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