Author + information
- Fnu Abhishek,
- Zheng Zhang,
- Ziling Qin,
- Samuel C. Dudley Jr.,
- Yanbing Wang,
- Kaustubh Dabhadkar,
- Marwan Refaat,
- Moussa Mansour,
- Jeremy Ruskin and
- Edwin Heist
Background: Limited data exist on the outcomes of patients who cross over to alternative strategies of rate and rhythm control for atrial fibrillation (AF). We investigated the reasons for crossover to alternative treatment strategies and its impact on mortality in patients who were enrolled in the AFFIRM trial.
Methods: Two-sample t-test and chi-squared tests were used to compare the reasons for crossover vs. non-crossover in each arm. Survival analyses were conducted to assess the impact of crossover on all-cause and cardiac mortality.
Results: A total of 842 out of 4,060 patients underwent crossover to the alternative treatment arms in AFFIRM. The rate of crossover from rhythm to rate control (594/2033, 29.2%) was more frequent than the rate of crossover from rate to rhythm control (248/2027, 12.2%, p < 0.0001). The leading reasons for crossover from rhythm to rate control were failure to maintain sinus rhythm (272/594, 45.8%) and intolerable side effects (122/594, 20.5%). In comparison, the major reasons for crossover from rate to rhythm control were failure to control AF symptoms (159/248, 64.1%) and intolerable side effects (9/248, 3.6%) (p<0.0001 comparing reasons for crossover between treatment arms). During AFFIRM, a total of 666 deaths occurred. There was significantly decreased all-cause (adjusted HR: 0.61, 95% CI: 0.48-0.78, p < 0.0001) and cardiac mortality (adjusted HR: 0.61, 95% CI: 0.43-0.88, p = 0.008) in patients who crossed over from rhythm to rate control as compared to those who continued rhythm control. There was a non-significant trend towards decreased all-cause (adjusted HR: 0.76, 95% CI: 0.53-1.10, p = 0.14) and cardiac mortality (adjusted HR: 0.70, 95% CI: 0.42-1.18, p = 0.18) in patients who crossed over from rate to rhythm control compared to those who continued rate control.
Conclusions: Rhythm control was abandoned more commonly than rate control in AFFIRM. Our findings of decreased mortality with crossover from rhythm to rate control and a trend towards decreased mortality with crossover from rate to rhythm control demonstrate that crossover to alternate treatment strategy is reasonable in AF patients when the initially selected strategy is Ineffective/poorly tolerated.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: AF Miscellaneous and Surgical Issues
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1236-079
- 2017 American College of Cardiology Foundation