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Abstract PDF PDA Full Text PowerPoint Slide Set Perspective by Cain, M. E. Editorial by Falk, R. H. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background There are two approaches to the treatment of atrial fibrillation: one is cardioversion and treatment with antiarrhythmic drugs to maintain sinus rhythm, and the other is the use of rate-controlling drugs, allowing atrial fibrillation to persist. In both approaches, the use of anticoagulant drugs is recommended.

Methods We conducted a randomized, multicenter comparison of these two treatment strategies in patients with atrial fibrillation and a high risk of stroke or death. The primary end point was overall mortality.

Results A total of 4060 patients (mean [±SD] age, 69.7±9.0 years) were enrolled in the study; 70.8 percent had a history of hypertension, and 38.2 percent had coronary artery disease. Of the 3311 patients with echocardiograms, the left atrium was enlarged in 64.7 percent and left ventricular function was depressed in 26.0 percent. There were 356 deaths among the patients assigned to rhythm-control therapy and 310 deaths among those assigned to rate-control therapy (mortality at five years, 23.8 percent and 21.3 percent, respectively; hazard ratio, 1.15 [95 percent confidence interval, 0.99 to 1.34]; P=0.08). More patients in the rhythm-control group than in the rate-control group were hospitalized, and there were more adverse drug effects in the rhythm-control group as well. In both groups, the majority of strokes occurred after warfarin had been stopped or when the international normalized ratio was subtherapeutic.

Conclusions Management of atrial fibrillation with the rhythm-control strategy offers no survival advantage over the rate-control strategy, and there are potential advantages, such as a lower risk of adverse drug effects, with the rate-control strategy. Anticoagulation should be continued in this group of high-risk patients.

Initial therapy for atrial fibrillation is often directed toward the maintenance of sinus rhythm by means of cardioversion and the use of antiarrhythmic drugs.¹⁵ The rationale for this "rhythm-control" approach includes the possibility of fewer symptoms, better exercise tolerance, a lower risk of stroke, eventual discontinuation of long-term anticoagulant therapy, better quality of life, and better survival, if sinus rhythm can be maintained.³ However, atrial fibrillation is often poorly responsive to antiarrhythmic drugs, which may also have serious adverse effects.^16,17,18,19

An accepted, though often secondary, alternative to antiarrhythmic-drug therapy is a strategy simply to control the ventricular response rate of atrial fibrillation with the use of atrioventricular nodal blocking agents or ablation of the atrioventricular junction and pacemaker implantation,^3,4,20,21 in conjunction with continuing anticoagulation.^5,6,7 This "rate-control" approach may simplify therapy and permit the use of drugs that are less toxic than antiarrhythmic drugs, although anticoagulation is thought to be more important with this strategy.

In the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study, we compared the effects of long-term treatment with these two strategies.^3,22,23

Methods

Patients

Patients who were at least 65 years of age or who had other risk factors for stroke or death could be enrolled in this study. The overriding criteria for enrollment were that (in the clinical judgment of the investigators) atrial fibrillation was likely to be recurrent; atrial fibrillation was likely to cause illness or death; long-term treatment for atrial fibrillation was warranted; anticoagulant therapy was not contraindicated; the patient was eligible to undergo trials of at least two drugs in both treatment strategies; and treatment with either strategy could be initiated immediately after randomization.^22,23

The institutional review boards of the University of Washington and each of the 213 individual clinical sites and their satellite sites approved of the protocol. Every patient gave written informed consent for the study.

Rhythm-Control Strategy

In the rhythm-control group, the antiarrhythmic drug used was chosen by the treating physician.^24,25 Attempts to maintain sinus rhythm could include cardioversion as necessary. The following drugs were acceptable for use, according to the protocol: amiodarone, disopyramide, flecainide, moricizine, procainamide, propafenone, quinidine, sotalol, and combinations of these drugs. When dofetilide became available, it also could be used. Specific guidelines for the use of antiarrhythmic drugs were imposed.^22,26

Rate-Control Strategy

The therapeutic target in this group was heart-rate control. Drugs that were acceptable in the protocol for this purpose were beta-blockers, calcium-channel blockers (verapamil and diltiazem), digoxin, and combinations of these drugs. Heart-rate control during atrial fibrillation was assessed both at rest and during activity, which usually consisted of a six-minute walk.^22,27 The goal was a heart rate not higher than 80 beats per minute at rest and not higher than 110 beats per minute during the six-minute walk test.

Other Therapeutic Considerations

After standard approaches to treatment were exhausted, but not before the failure of at least two trials of either a rhythm-control drug or a rate-control drug, patients could be considered for nonpharmacologic therapy, such as radio-frequency ablation, a maze procedure, and pacing techniques, as appropriate to their randomized strategy.²² The goal for anticoagulation with warfarin was an international normalized ratio (INR) of 2.0 to 3.0. In the rhythm-control group, continuous anticoagulation was encouraged but could be stopped at the physician's discretion if sinus rhythm had apparently been maintained for at least 4, and preferably 12, consecutive weeks with antiarrhythmic-drug therapy. In the rate-control group, continuous anticoagulation was mandated by the protocol.^5,6,7

Statistical Analysis

The primary end point was overall mortality. A composite secondary end point comprised death, disabling stroke, disabling anoxic encephalopathy, major bleeding, and cardiac arrest.

Randomization was stratified only according to clinical site. The base-line characteristics of patients were compared with chi-square tests and t-tests. The primary analysis was an intention-to-treat comparison of the time to death from any cause, adjusted for 10 interim analyses. For all time-to-event analyses, rates were estimated by the method of Kaplan and Meier²⁸ and were compared by the log-rank test. Patients' data were censored at the time of last contact or withdrawal from the study or at the time of death, if the analysis was for an end point other than death.

Secondary analyses were conducted to evaluate results within prespecified subgroups and to adjust the primary end point for base-line characteristics. The prespecified covariates were age (as a continuous variable), sex, rhythm at randomization (sinus rhythm vs. atrial fibrillation), a first episode of atrial fibrillation (vs. a recurrent episode), the presence or absence of coronary artery disease, the presence or absence of hypertension, the presence or absence of congestive heart failure, the left ventricular ejection fraction (>50, 40 to 49, 30 to 39, or <30 percent), and the duration of atrial fibrillation. Unadjusted hazard ratios for death from any cause with the rhythm-control strategy as compared with the rate-control strategy were estimated in each subgroup. In addition, these covariates were used to construct a multivariate Cox proportional-hazards survival model with a stepwise procedure. Covariates that were significantly associated with mortality were then used to adjust the primary treatment comparison. All P values were two-tailed.

A data and safety monitoring board reviewed the study twice yearly. A group sequential monitoring technique, with a Lan–DeMets boundary and an O'Brien–Fleming–type alpha spending function, was used.^22,29,30,31

Results

Characteristics of the Patients

Of the 7401 patients who were eligible and offered enrollment, 4060 were enrolled. During the course of the study, 71 patients withdrew their consent for participation, and survival at the end of follow-up was ultimately unknown in 26 patients. The mean follow-up time was 3.5 years, with a maximum of 6 years. Base-line clinical data for the 4060 enrolled patients are summarized in Table 1 and elsewhere.²³ The mean (±SD) age was 69.7±9.0 years; 39.3 percent were women and 11.4 percent members of an ethnic minority group. A total of 70.8 percent of the patients had hypertension, which was the predominant cardiac diagnosis in 50.8 percent; 38.2 percent of the patients had coronary artery disease (which was the predominant cardiac diagnosis in 26.1 percent). More than one third were enrolled after having had a first episode of atrial fibrillation; more than 90 percent had had the qualifying episode within the previous six weeks; and in more than two thirds the qualifying episode lasted at least two days. The rate-control and rhythm-control groups were balanced according to base-line characteristics.

View this table: [in this window] [in a new window]   Table 1. Base-Line Characteristics of the Patients.

 
Therapy

Table 2 outlines the drugs used in the two study groups. The use of combinations of two or more agents was common.

View this table: [in this window] [in a new window]   Table 2. Drugs Used in the Rate-Control Group and the Rhythm-Control Group.

 
In the rate-control group, beta-blocking drugs were used initially in nearly one half of the patients, and of the calcium-channel blockers, diltiazem was used more commonly than verapamil. However, changes in therapy were frequent. At the five-year visit, 34.6 percent of the patients were in sinus rhythm, and over 80 percent of those in atrial fibrillation had adequate heart-rate control. Radiofrequency ablation to modify or eliminate atrioventricular conduction was used in 105 (5.2 percent) of the patients in the rate-control group after drug failure. During the course of the study, 248 patients crossed over from the rate-control group to the rhythm-control group (actuarial rate of crossover, 7.8 percent, 11.6 percent, and 14.9 percent after one, three, and five years, respectively). Eighty-six of these patients had crossed back to the rate-control group by the end of the study. Uncontrolled symptoms due to atrial fibrillation and congestive heart failure were the most common reasons for the initial crossover to rhythm control in this group.

In the rhythm-control group, more than two thirds of patients started therapy with amiodarone or sotalol, and by the end of the study almost two thirds of the patients in this group had undergone at least one trial of amiodarone. Maintenance of sinus rhythm was not itself a primary end point. Patients with intermittent, self-terminating episodes of atrial fibrillation could have been enrolled in the study. The prevalence of sinus rhythm in the rhythm-control group at follow-up was 82.4 percent, 73.3 percent, and 62.6 percent at one, three, and five years, respectively. Electrical cardioversion was attempted once during follow-up in 368 patients, twice in 214 patients, and three or more times in 187 patients in this group. Fourteen patients underwent radiofrequency ablation for atrial flutter or fibrillation; three received an implantable atrial cardioverter (a protocol violation); three underwent a surgical maze procedure³²; and one underwent a catheter-based maze procedure. During the course of the study, 594 patients assigned to the rhythm-control group crossed over to the rate-control group (actuarial rate of crossover, 16.7 percent, 27.3 percent, and 37.5 percent after one, three, and five years, respectively; P<0.001 for the comparison with the rate-control group). Sixty-one of these patients had crossed back to the rhythm-control group by the end of the study. Inability to maintain sinus rhythm and drug intolerance were the chief reasons for abandonment of a rhythm-control strategy.

At each assessment during the study, more than 85 percent of patients in the rate-control group were taking warfarin. After the first four months of the trial, there was a decline in the use of warfarin in the rhythm-control group, but the overall proportion of patients receiving warfarin remained approximately 70 percent throughout the trial. A total of 62.3 percent of INR values measured at follow-up visits were within the recommended range (2.0 to 3.0).

Mortality

The primary end point of overall mortality is summarized in Figure 1, and major adverse events are summarized in Table 3. More deaths occurred in the rhythm-control group than in the rate-control group, but the difference in mortality between the two groups was not statistically significant (P=0.08; hazard ratio, 1.15 [95 percent confidence interval, 0.99 to 1.34]; both adjusted for interim monitoring but not for base-line covariates). The rates of the composite end point of death, disabling stroke, disabling anoxic encephalopathy, major bleeding, or cardiac arrest were also similar in the two groups (P=0.33).

View larger version (13K): [in this window] [in a new window]   Figure 1. Cumulative Mortality from Any Cause in the Rhythm-Control Group and the Rate-Control Group. Time zero is the day of randomization. Data have been truncated at five years.

 

View this table: [in this window] [in a new window]   Table 3. Adverse Events.

 
Central Nervous System Events

Ischemic strokes occurred in 77 and 80 patients in the rate-control and rhythm-control groups, respectively (Table 3), for an annual rate of approximately 1 percent per year in each group. Most occurred in patients in whom warfarin had been stopped or in whom the INR was subtherapeutic. The proportions of patients with ischemic stroke, primary intracerebral hemorrhage, subdural or subarachnoid hemorrhage, or disabling anoxic encephalopathy were similar in the two treatment groups.

Other Adverse Events

Other adverse events noted during the trial are listed in Table 3 and Table 4. Hemorrhage not involving the central nervous system was uncommon. Most of these patients were taking warfarin at the time of their event and had an INR of 4.3±4.9 (after the exclusion of three extreme values) near the time of the event. Other cardiac arrhythmias occurred, but only rarely, in the two groups (Table 3).

View this table: [in this window] [in a new window]   Table 4. Additional Adverse Events or Clinical Findings Prompting Discontinuation of a Drug.

 
Other Observations

Scores on the Mini–Mental State Examination, a test of cognitive ability,³³ and selected measures of quality of life were similar in the two groups at all time points. The number of patients needing hospitalization during follow-up was greater in the rhythm-control group than in the rate-control group (1374 [80.1 percent] vs. 1220 [73.0 percent], P<0.001).

The hazard ratios for death in each of the prespecified subgroups are shown in Figure 2. The rhythm-control strategy was associated with a higher risk of death than the rate-control strategy among older patients, those without congestive heart failure, and those with coronary artery disease. After adjustment for the prespecified covariates that were statistically significant in a Cox proportional-hazards model (age, coronary artery disease, congestive heart failure, left ventricular ejection fraction, and hypertension), the trend toward a higher risk of death in the rhythm-control group than in the rate-control group persisted (hazard ratio, 1.18 [95 percent confidence interval, 0.99 to 1.41]; P=0.07).

View larger version (18K): [in this window] [in a new window]   Figure 2. Hazard Ratios for Death in Prespecified Subgroups. The numbers in the groups do not total 4060 for all variables because of incomplete reporting. The ratios shown are for the rhythm-control group as compared with the rate-control group.

 
Discussion

In this study, we compared rate-control and rhythm-control strategies for the treatment of atrial fibrillation. The population in this study is representative of the majority of patients with atrial fibrillation. Patients who are elderly (65 years of age or older) have the highest incidence and prevalence of this common tachyarrhythmia^{34,35,36,37,38} and are increasing in number.^1,39 To allow patients to remain in their assigned treatment groups, the protocol permitted the use of multiple drugs and nonpharmacologic therapies that the investigators considered effective in patients with atrial fibrillation.²² The crossover rate was significantly greater among the patients initially assigned to rhythm control than among those assigned to rate control, in keeping with the fact that antiarrhythmic drug therapies frequently fail.^2,3,15,18 However, crossover rates were within the ranges predicted by the protocol.²² Only a small number of patients in the study were treated with nonpharmacologic therapies. Indeed, many nonpharmacologic therapies may not be applicable to elderly patients with atrial fibrillation.^40,41

In this study of patients with atrial fibrillation and risk factors for stroke, the strategy of restoring and maintaining sinus rhythm had no clear advantage over the strategy of controlling the ventricular rate and allowing atrial fibrillation to persist. There was a trend toward increased mortality in association with the rhythm-control strategy (P=0.08). In a multivariate analysis with adjustment for prespecified covariates, the trend toward a survival advantage with the rate-control strategy was essentially unchanged (P=0.07). Follow-up was relatively long (3.5 years, on average), and the trend toward a difference in mortality did not begin to emerge until near the second year of follow-up. All comparisons of subgroups according to the prespecified covariates either showed nonsignificant differences or showed a benefit with rate control. Thus, we did not find any benefit in association with the rhythm-control strategy. Analysis of death according to specific causes is ongoing.

Stroke is probably the most serious direct clinical consequence of atrial fibrillation.^34,35,36 The rates of ischemic stroke were low, at approximately 1 percent per year in both groups. The majority of strokes in both groups occurred in patients who had stopped taking warfarin or whose INR was subtherapeutic at the time of the stroke, in general agreement with previously reported observations.⁴²

Proarrhythmia (i.e., the presumed induction of ventricular arrhythmia by antiarrhythmic drugs) was uncommon in this study, and the restricted use of many antiarrhythmic drugs (particularly class I drugs) imposed by the protocol may explain this finding. However, torsade de pointes or bradycardic arrest occurred more often in the rhythm-control group than in the rate-control group. The cardiac rhythm in some of the patients in the rate-control group was sinus rhythm at times during follow-up. The cardiac rhythm was classified only on the day of the follow-up visit, and atrial fibrillation could have been present at other times. The high prevalence of sinus rhythm may be due to the inclusion of patients with paroxysmal atrial fibrillation,¹⁶ adequate control of blood pressure in patients with hypertension, and the antiarrhythmic effects of beta-blockers and calcium-channel blockers.

The patients in the rhythm-control group were significantly more likely to be hospitalized and have adverse drug effects than those in the rate-control group, in general agreement with findings previously reported.⁴³ These findings probably have important cost implications.

Our study tested a treatment strategy to maintain sinus rhythm. Use of a single drug could have yielded a different result (either better or worse), but the ability to use multiple drugs increased the chance that any individual patient would maintain sinus rhythm. Patients with frequent or severe symptoms might have been considered unsuitable for a rate-control strategy and therefore may not have been enrolled by some investigators. Moreover, the results probably cannot be generalized to younger patients without risk factors for stroke (i.e., patients with primary, or "lone," atrial fibrillation), particularly those with paroxysmal atrial fibrillation. Nevertheless, our results apply to the majority of patients with atrial fibrillation. Finally, some of the patients in each of the two groups had paroxysmal atrial fibrillation, and thus, the prevalence of sinus rhythm at any time was high, even in the rate-control group.

Patients with atrial fibrillation often need treatment for decades, not years. However, the survival curves appear to be diverging, not converging, later in follow-up. Furthermore, the adverse effects due to the most commonly used drug, amiodarone, might be reasonably expected to increase with longer use.

None of the presumed benefits of rhythm control noted above were confirmed in this study. The implication is that rate control should be considered a primary approach to therapy and that rhythm control, if used, may be abandoned early if it is not fully satisfactory. Our data also suggest that continuous anticoagulation is warranted in all patients with atrial fibrillation and risk factors for stroke, even when sinus rhythm appears to be restored and maintained.

Supported (under contract N01-HC-55139) by the National Heart, Lung, and Blood Institute.

Dr. Wyse has reported that he receives research support from Medtronic and Cardiome Pharma, is a consultant for AstraZeneca and Cardiome Pharma, is a speaker for Guidant, and is a member of the data and safety monitoring boards of Procter & Gamble, Cardiome Pharma, Orion Pharma, and Bristol-Myers Squibb/Sanofi–Synthelabo. Dr. Waldo has reported that he receives research support from AstraZeneca and Guidant, is on the speakers' bureaus of many companies, and is a consultant to Procter & Gamble, 3-M Pharmaceuticals, AstraZeneca, Pfizer, Solvay, and CryoCor. Dr. DiMarco has reported that he receives research support from Medtronic, Guidant, and Procter & Gamble and that he is a consultant to Bayer, Novartis, and Pfizer. Dr. Greene has reported that he is a member of the data and safety monitoring board for Procter & Gamble and CryoCor.

We are indebted to all the patients whose participation made this study possible and to Wyeth–Ayerst Laboratories for the generous contribution of amiodarone for the study.

^* A complete list of the AFFIRM investigators and coordinators and their affiliations has been published elsewhere (Am Heart J 2002;143:991-1001).

Source Information

The AFFIRM writing group (D.G. Wyse, A.L. Waldo, J.P. DiMarco, M.J. Domanski, Y. Rosenberg, E.B. Schron, J.C. Kellen, H.L. Greene, M.C. Mickel, J.E. Dalquist, and S.D. Corley) assumes overall responsibility for the content of the manuscript.

Address reprint requests to the AFFIRM Clinical Trial Center, Axio Research, 2601 4th Ave., Ste. 200, Seattle, WA 98121, or to leong{at}axioresearch.com.

References

1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study. JAMA 2001;285:2370-2375. [Free Full Text]
2. The National Heart, Lung, and Blood Institute Working Group on Atrial Fibrillation. Atrial fibrillation: current understandings and research imperatives. J Am Coll Cardiol 1993;22:1830-1834. [Abstract]
3. Waldo AL. Management of atrial fibrillation: the need for AFFIRMative action. Am J Cardiol 1999;84:698-700. [CrossRef][Web of Science][Medline]
4. Narasimham C, Blanck Z, Akhtar M. Atrioventricular nodal modification and atrioventricular junctional ablation for control of ventricular rate in atrial fibrillation. J Cardiovasc Electrophysiol 1998;9:Suppl:S146-S150. [Web of Science][Medline]
5. Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med 1995;98:476-484. [CrossRef][Web of Science][Medline]
6. Flegel KM, Shipley MJ, Rose G. Risk of stroke in non-rheumatic atrial fibrillation. Lancet 1987;1:526-529. [Erratum, Lancet 1987;1:878.] [CrossRef][Web of Science][Medline]
7. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998;98:946-952. [Free Full Text]
8. Wyse DG, Love JC, Yao Q, et al. Atrial fibrillation: a risk factor for increased mortality -- an AVID registry analysis. J Interv Card Electrophysiol 2001;5:267-273. [CrossRef][Web of Science][Medline]
9. Dries DL, Exner DV, Gersh BJ, Domanski MJ, Waclawiw MA, Stevenson LW. Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. J Am Coll Cardiol 1998;32:695-703. [Free Full Text]
10. Stewart S, MacIntyre K, Chalmers JW, et al. Trends in case-fatality in 22968 patients admitted for the first time with atrial fibrillation in Scotland, 1986-1995. Int J Cardiol 2002;82:229-236. [CrossRef][Web of Science][Medline]
11. Taylor FC, Cohen H, Ebrahim S. Systematic review of long term anticoagulation or antiplatelet treatment in patients with non-rheumatic atrial fibrillation. BMJ 2001;322:321-326. [Erratum, BMJ 2001;322:587.] [Free Full Text]
12. Hart RG, Halperin JL. Atrial fibrillation and thromboembolism: a decade of progress in stroke prevention. Ann Intern Med 1999;131:688-695. [Free Full Text]
13. Albers GW, Dalen JE, Laupacis A, Manning WJ, Petersen P, Singer DE. Antithrombotic therapy in atrial fibrillation. Chest 2001;119:Suppl:194S-206S. [Free Full Text]
14. Gage BF, Boechler M, Doggette AL, et al. Adverse outcomes and predictors of underuse of antithrombotic therapy in Medicare beneficiaries with chronic atrial fibrillation. Stroke 2000;31:822-827. [Free Full Text]
15. Falk RH. Atrial fibrillation. N Engl J Med 2001;344:1067-1078. [Erratum, N Engl J Med 2001;344:1876.] [Free Full Text]
16. Fuster V, Rydén LE, Asinger RW, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) developed in collaboration with the North American Society for Pacing and Electrophysiology. J Am Coll Cardiol 2001;38:1231-1266. [Free Full Text]
17. Van Gelder IC, Crijns HJ, Tieleman RG, et al. Chronic atrial fibrillation: success of serial cardioversion therapy and safety of oral anticoagulation. Arch Intern Med 1996;156:2585-2592. [Free Full Text]
18. Crijns HJ, Van Gelder IC, Van Gilst WH, Hillege H, Gosselink AM, Lie KI. Serial antiarrhythmic drug treatment to maintain sinus rhythm after electrical cardioversion for chronic atrial fibrillation or atrial flutter. Am J Cardiol 1991;68:335-341. [CrossRef][Web of Science][Medline]
19. Brodsky MA, Allen BJ, Walker CJ III, Casey TP, Luckett CT, Henry WL. Amiodarone for maintenance of sinus rhythm after conversion of atrial fibrillation in the setting of a dilated left atrium. Am J Cardiol 1987;60:572-575. [CrossRef][Web of Science][Medline]
20. Scheinman MM, Morady F. Nonpharmacological approaches to atrial fibrillation. Circulation 2001;103:2120-2125. [Free Full Text]
21. Wood MA, Brown-Mahoney C, Kay GN, Ellenbogen KA. Clinical outcomes after ablation and pacing therapy for atrial fibrillation: a meta-analysis. Circulation 2000;101:1138-1144. [Free Full Text]
22. The Planning and Steering Committees of the AFFIRM Study for the NHLBI AFFIRM Investigators. Atrial Fibrillation Follow-up Investigation of Rhythm Management -- the AFFIRM study design. Am J Cardiol 1997;79:1198-1202. [CrossRef][Web of Science][Medline]
23. The AFFIRM Investigators. Baseline characteristics of patients with atrial fibrillation: the AFFIRM Study. Am Heart J 2002;143:991-1001. [CrossRef][Web of Science][Medline]
24. Miller MR, McNamara RL, Segal JB, et al. Efficacy of agents for pharmacologic conversion of atrial fibrillation and subsequent maintenance of sinus rhythm: a meta-analysis of clinical trials. J Fam Pract 2000;49:1033-1046. [Web of Science][Medline]
25. Nichol G, McAlister F, Pham B, et al. Meta-analysis of randomised controlled trials of the effectiveness of anti-arrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation. Heart 2002;87:535-543. [Free Full Text]
26. AFFIRM Investigators. Maintenance of normal sinus rhythm in patients with a history of atrial fibrillation: the effects of antiarrhythmic drugs in the AFFIRM Study. In: North American Society of Pacing and Electrophysiology Late-Breaking Clinical Trials, 2002. abstract. (Accessed October 16, 2002, at http://www.naspehighlights.org/summary/summary.asp?sid=1&stid=21&1d=2002.)
27. Lipkin DP, Scriven AJ, Crake T, Poole-Wilson PA. Six minute walking test for assessing exercise capacity in chronic heart failure. Br Med J (Clin Res Ed) 1986;292:653-655.
28. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-81.
29. Cox DR. Regression models and life-tables. J R Stat Soc [B] 1972;34: 187-220.
30. Lan KKG, DeMets DL. Discrete sequential boundaries for clinical trials. Biometrika 1983;70:659-663. [Free Full Text]
31. O'Brien PC, Fleming TR. A multiple testing procedure for clinical trials. Biometrics 1979;35:549-556. [CrossRef][Web of Science][Medline]
32. Cox JL, Ad N, Palazzo T, et al. Current status of the maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 2000;12:15-19. [Medline]
33. Folstein MF, Folstein SE, McHugh PR. "Mini-Mental State": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198. [CrossRef][Web of Science][Medline]
34. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly: the Framingham Study. Arch Intern Med 1987;147:1561-1564. [Free Full Text]
35. Wolf PA, Dawber TR, Thomas HE Jr, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham Study. Neurology 1978;28:973-977. [Free Full Text]
36. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983-988. [Free Full Text]
37. Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Am J Cardiol 1994;74:236-241. [CrossRef][Web of Science][Medline]
38. Manolio TA, Furberg CD, Rautaharju PM, et al. Cardiac arrhythmias on 24-h ambulatory electrocardiography in older women and men: the Cardiovascular Health Study. J Am Coll Cardiol 1994;23:916-925. [Abstract]
39. Roger VL, Jacobsen SJ, Weston SA, et al. Trends in the incidence and survival of patients with hospitalized myocardial infarction, Olmsted County, Minnesota, 1979 to 1994. Ann Intern Med 2002;136:341-348. [Free Full Text]
40. Epstein AE, Vidaillet H, Greene HL, et al. Frequency of symptomatic atrial fibrillation in patients enrolled in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. J Cardiovasc Electrophysiol 2002;13:667-671. [CrossRef][Web of Science][Medline]
41. Oral H, Knight BP, Tada H, et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 2002;105:1077-1081. [Free Full Text]
42. Stroke Prevention in Atrial Fibrillation Study: final results. Circulation 1991;84:527-539. [Free Full Text]
43. Hohnloser SH, Kuck K-H, Lilienthal J. Rhythm or rate control in atrial fibrillation -- Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet 2000;356:1789-1794. [CrossRef][Web of Science][Medline]

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Related Letters:

Atrial Fibrillation — Rate versus Rhythm Control
Kühlkamp V., Seipel L., Healy E. C., Bhaskarabhatla K., Manning W. J., Wyse D. G., Van Gelder I. C., Crijns H. J.G.M.
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N Engl J Med 2003; 348:1284-1286, Mar 27, 2003. Correspondence

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• De Potter, T., Berruezo, A., Mont, L., Matiello, M., Tamborero, D., Santibanez, C., Benito, B., Zamorano, N., Brugada, J. (2009). Left ventricular systolic dysfunction by itself does not influence outcome of atrial fibrillation ablation. Europace 0: eup309v1-eup309 [Abstract] [Full Text]  
• Nishida, K., Michael, G., Dobrev, D., Nattel, S. (2009). Animal models for atrial fibrillation: clinical insights and scientific opportunities. Europace 0: eup328v1-eup328 [Abstract] [Full Text]  
• Shotan, A., Garty, M., Blondhein, D. S., Meisel, S. R., Lewis, B. S., Shochat, M., Grossman, E., Porath, A., Boyko, V., Zimlichman, R., Caspi, A., Gottlieb, S., for the HFSIS Steering Committee and Investigators, (2009). Atrial fibrillation and long-term prognosis in patients hospitalized for heart failure: results from heart failure survey in Israel (HFSIS). Eur Heart J 0: ehp422v1-ehp422 [Abstract] [Full Text]  
• Burkhardt, J. D., Natale, A. (2009). New Technologies in Atrial Fibrillation Ablation. Circulation 120: 1533-1541 [Full Text]  
• Anter, E., Callans, D. J. (2009). Pharmacological and Electrical Conversion of Atrial Fibrillation to Sinus Rhythm Is Worth the Effort. Circulation 120: 1436-1443 [Full Text]  
• Wyse, D. G. (2009). Cardioversion of Atrial Fibrillation for Maintenance of Sinus Rhythm: A Road to Nowhere. Circulation 120: 1444-1452 [Full Text]  
• Piccini, J. P., Hernandez, A. F., Zhao, X., Patel, M. R., Lewis, W. R., Peterson, E. D., Fonarow, G. C., Get With The Guidelines Steering Committee and Hos, (2009). Quality of care for atrial fibrillation among patients hospitalized for heart failure.. J Am Coll Cardiol 54: 1280-1289 [Abstract] [Full Text]  
• Connolly, S. J., Crijns, H. J.G.M., Torp-Pedersen, C., van Eickels, M., Gaudin, C., Page, R. L., Hohnloser, S. H., for the ATHENA Investigators, (2009). Analysis of Stroke in ATHENA: A Placebo-Controlled, Double-Blind, Parallel-Arm Trial to Assess the Efficacy of Dronedarone 400 mg BID for the Prevention of Cardiovascular Hospitalization or Death From Any Cause in Patients With Atrial Fibrillation/Atrial Flutter. Circulation 120: 1174-1180 [Abstract] [Full Text]  
• Freedman, J. E., Gersh, B. J. (2009). New Therapies for Stroke Prevention in Atrial Fibrillation: The Long Road to Enhanced Efficacy. Circulation 120: 1024-1026 [Full Text]  
• Chan, P. S., Nallamothu, B. K., Oral, H. (2009). Amiodarone or dronedarone for atrial fibrillation: too early to know the winner?. J Am Coll Cardiol 54: 1096-1098 [Full Text]  
• CHOWDHURY, P., LEWIS, W. R., SCHWEIKERT, R. A., CUMMINGS, J. E. (2009). Ablation of atrial fibrillation: What can we tell our patients?. Cleveland Clinic Journal of Medicine 76: 543-550 [Abstract] [Full Text]  
• Dunser, M. W., Hasibeder, W. R. (2009). Sympathetic Overstimulation During Critical Illness: Adverse Effects of Adrenergic Stress. J Intensive Care Med 24: 293-316 [Abstract]  
• Marcus, G. M., Keung, E., Scheinman, M. M. (2009). The year in review of clinical cardiac electrophysiology.. J Am Coll Cardiol 54: 777-787 [Full Text]  
• Wilber, D. J. (2009). Pursuing sinus rhythm in patients with persistent atrial fibrillation: when is it too late?. J Am Coll Cardiol 54: 796-798 [Full Text]  
• Betts, T. R (2009). Is rate more important than rhythm in treating atrial fibrillation? Yes. BMJ 339: b3173-b3173 [Full Text]  
• Mitchell, A. R J (2009). Is rate more important than rhythm in treating atrial fibrillation? No. BMJ 339: b3174-b3174 [Full Text]  
• Patel, C., Yan, G.-X., Kowey, P. R. (2009). Dronedarone. Circulation 120: 636-644 [Abstract] [Full Text]  
• Terasawa, T., Balk, E. M., Chung, M., Garlitski, A. C., Alsheikh-Ali, A. A., Lau, J., Ip, S. (2009). Systematic Review: Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation. ANN INTERN MED 151: 191-202 [Abstract] [Full Text]  
• Kalavrouziotis, D., Buth, K. J., Vyas, T., Ali, I. S. (2009). Preoperative atrial fibrillation decreases event-free survival following cardiac surgery. Eur. J. Cardiothorac. Surg. 36: 293-299 [Abstract] [Full Text]  
• Reynolds, M. R., Zimetbaum, P., Josephson, M. E., Ellis, E., Danilov, T., Cohen, D. J. (2009). Cost-Effectiveness of Radiofrequency Catheter Ablation Compared With Antiarrhythmic Drug Therapy for Paroxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol 2: 362-369 [Abstract] [Full Text]  
• Bortone, A., Boveda, S., Pasquie, J.-L., Pujadas-Berthault, P., Marijon, E., Appetiti, A., Albenque, J.-P. (2009). Sinus rhythm restoration by catheter ablation in patients with long-lasting atrial fibrillation and congestive heart failure: impact of the left ventricular ejection fraction improvement on the implantable cardioverter defibrillator insertion indication. Europace 11: 1018-1023 [Abstract] [Full Text]  
• Gemein, C., Schauerte, P., Hatam, N., Rana, O. R., Saygili, E., Meyer, C., Eickholt, C., Schmid, M., Knackstedt, C., Zarse, M., Mischke, K. (2009). Targeting of cardiac autonomic plexus for modulation of intracardiac neural tone. Europace 11: 1090-1096 [Abstract] [Full Text]  
• Andersen, S. S., Hansen, M. L., Gislason, G. H., Schramm, T. K., Folke, F., Fosbol, E., Abildstrom, S. Z., Madsen, M., Kober, L., Torp-Pedersen, C. (2009). Antiarrhythmic therapy and risk of death in patients with atrial fibrillation: a nationwide study. Europace 11: 886-891 [Abstract] [Full Text]  
• Kirchhof, P., Bax, J., Blomstrom-Lundquist, C., Calkins, H., Camm, A. J., Cappato, R., Cosio, F., Crijns, H., Diener, H.-C., Goette, A., Israel, C. W., Kuck, K.-H., Lip, G. Y.H., Nattel, S., Page, R. L., Ravens, U., Schotten, U., Steinbeck, G., Vardas, P., Waldo, A., Wegscheider, K., Willems, S., Breithardt, G. (2009). Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled 'research perspectives in atrial fibrillation'. Europace 11: 860-885 [Full Text]  
• Le Heuzey, J.-Y. (2009). The risk of antiarrhythmic drugs in atrial fibrillation: 20 years of controversies. Europace 11: 840-841 [Full Text]  
• Crandall, M. A., Bradley, D. J., Packer, D. L., Asirvatham, S. J. (2009). Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies. Mayo Clin Proc. 84: 643-662 [Abstract] [Full Text]  
• Kirchhof, P., Bax, J., Blomstrom-Lundquist, C., Calkins, H., John Camm, A., Cappato, R., Cosio, F., Crijns, H., Diener, H.-C., Goette, A., Israel, C. W., Kuck, K.-H., Lip, G. Y.H., Nattel, S., Page, R. L., Ravens, U., Schotten, U., Steinbeck, G., Vardas, P., Waldo, A., Wegscheider, K., Willems, S., Breithardt, G. (2009). Early and comprehensive management of atrial fibrillation: executive summary of the proceedings from the 2nd AFNET-EHRA consensus conference 'research perspectives in AF'. Eur Heart J 0: ehp235v1-ehp235 [Abstract] [Full Text]  
• Friberg, L, Hammar, N, Edvardsson, N, Rosenqvist, M (2009). The prognosis of patients with atrial fibrillation is improved when sinus rhythm is restored: report from the Stockholm Cohort of Atrial Fibrillation (SCAF). Heart 95: 1000-1005 [Abstract] [Full Text]  
• Forleo, G. B., Tondo, C. (2009). Atrial fibrillation: cure or treat?. Ther Adv Cardiovasc Dis 3: 187-196 [Abstract]  
• Goette, A., Bukowska, A., Dobrev, D., Pfeiffenberger, J., Morawietz, H., Strugala, D., Wiswedel, I., Rohl, F.-W., Wolke, C., Bergmann, S., Bramlage, P., Ravens, U., Lendeckel, U. (2009). Acute atrial tachyarrhythmia induces angiotensin II type 1 receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles. Eur Heart J 30: 1411-1420 [Abstract] [Full Text]  
• Shelton, R J, Clark, A L, Goode, K, Rigby, A S, Houghton, T, Kaye, G C, Cleland, J G F (2009). A randomised, controlled study of rate versus rhythm control in patients with chronic atrial fibrillation and heart failure: (CAFE-II Study). Heart 95: 924-930 [Abstract] [Full Text]  
• Segal, O. R (2009). Rate control for atrial fibrillation: one drug or two?. Postgrad. Med. J. 85: 281-282 [Full Text]  
• Anter, E., Jessup, M., Callans, D. J. (2009). Atrial Fibrillation and Heart Failure: Treatment Considerations for a Dual Epidemic. Circulation 119: 2516-2525 [Full Text]  
• Mattson-DiCecca, A. A., Reynolds, E. (2009). Update: A 60-Year-Old Woman With Atrial Fibrillation. JAMA 301: 1808-1808 [Full Text]  
• De Vos, C B, Weijs, B, Crijns, H J G M, Cheriex, E C, Palmans, A, Habets, J, Prins, M H, Pisters, R, Nieuwlaat, R, Tieleman, R G (2009). Atrial tissue Doppler imaging for prediction of new-onset atrial fibrillation. Heart 95: 835-840 [Abstract] [Full Text]  
• Kleemann, T., Becker, T., Strauss, M., Schneider, S., Seidl, K. (2009). Prevalence and clinical impact of left atrial thrombus and dense spontaneous echo contrast in patients with atrial fibrillation and low CHADS2 score. Eur J Echocardiogr 10: 383-388 [Abstract] [Full Text]  
• Zimetbaum, P. J. (2009). Dronedarone for Atrial Fibrillation -- An Odyssey. NEJM 360: 1811-1813 [Full Text]  
• Hunt, S. A., Abraham, W. T., Chin, M. H., Feldman, A. M., Francis, G. S., Ganiats, T. G., Jessup, M., Konstam, M. A., Mancini, D. M., Michl, K., Oates, J. A., Rahko, P. S., Silver, M. A., Stevenson, L. W., Yancy, C. W. (2009). 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol 53: e1-e90 [Full Text]  
• Jessup, M., Abraham, W. T., Casey, D. E., Feldman, A. M., Francis, G. S., Ganiats, T. G., Konstam, M. A., Mancini, D. M., Rahko, P. S., Silver, M. A., Stevenson, L. W., Yancy, C. W. (2009). 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol 53: 1343-1382 [Full Text]  
• 2009 WRITING GROUP TO REVIEW NEW EVIDENCE AND UPDA, , Jessup, M., Abraham, W. T., Casey, D. E., Feldman, A. M., Francis, G. S., Ganiats, T. G., Konstam, M. A., Mancini, D. M., Rahko, P. S., Silver, M. A., Stevenson, L. W., Yancy, C. W. (2009). 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation. Circulation 119: 1977-2016 [Full Text]  
• 2005 WRITING COMMITTEE MEMBERS, , Hunt, S. A., Abraham, W. T., Chin, M. H., Feldman, A. M., Francis, G. S., Ganiats, T. G., Jessup, M., Konstam, M. A., Mancini, D. M., Michl, K., Oates, J. A., Rahko, P. S., Silver, M. A., Stevenson, L. W., Yancy, C. W. (2009). 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation. Circulation 119: e391-e479 [Full Text]  
• Balasubramaniam, R, Kistler, P M (2009). Atrial fibrillation in heart failure: the chicken or the egg?. Heart 95: 535-539 [Abstract] [Full Text]  
• Nabauer, M., Gerth, A., Limbourg, T., Schneider, S., Oeff, M., Kirchhof, P., Goette, A., Lewalter, T., Ravens, U., Meinertz, T., Breithardt, G., Steinbeck, G. (2009). The Registry of the German Competence NETwork on Atrial Fibrillation: patient characteristics and initial management. Europace 11: 423-434 [Abstract] [Full Text]  
• McBride, B. F. (2009). The Emerging Role of Antiarrhythmic Compounds With Atrial Selectivity in the Management of Atrial Fibrillation. J Clin Pharmacol 49: 258-267 [Abstract] [Full Text]  
• Kim, E. S.H., Menon, V. (2009). Status of Women in Cardiovascular Clinical Trials. Arterioscler. Thromb. Vasc. Bio. 29: 279-283 [Full Text]  
• Kato, K., Fujimaki, T., Yoshida, T., Oguri, M., Yajima, K., Hibino, T., Murohara, T. (2009). Impact of matrix metalloproteinase-2 levels on long-term outcome following pharmacological or electrical cardioversion in patients with atrial fibrillation. Europace 11: 332-337 [Abstract] [Full Text]  
• Doyle, J. F., Ho, K. M. (2009). Benefits and Risks of Long-term Amiodarone Therapy for Persistent Atrial Fibrillation: A Meta-analysis. Mayo Clin Proc. 84: 234-242 [Abstract] [Full Text]  
• Hohnloser, S. H., Crijns, H. J.G.M., van Eickels, M., Gaudin, C., Page, R. L., Torp-Pedersen, C., Connolly, S. J., the ATHENA Investigators, (2009). Effect of Dronedarone on Cardiovascular Events in Atrial Fibrillation. NEJM 360: 668-678 [Abstract] [Full Text]  
• Benjamin, E. J., Chen, P.-S., Bild, D. E., Mascette, A. M., Albert, C. M., Alonso, A., Calkins, H., Connolly, S. J., Curtis, A. B., Darbar, D., Ellinor, P. T., Go, A. S., Goldschlager, N. F., Heckbert, S. R., Jalife, J., Kerr, C. R., Levy, D., Lloyd-Jones, D. M., Massie, B. M., Nattel, S., Olgin, J. E., Packer, D. L., Po, S. S., Tsang, T. S.M., Van Wagoner, D. R., Waldo, A. L., Wyse, D. G. (2009). Prevention of Atrial Fibrillation: Report From a National Heart, Lung, and Blood Institute Workshop. Circulation 119: 606-618 [Abstract] [Full Text]  
• Krane, V., Heinrich, F., Meesmann, M., Olschewski, M., Lilienthal, J., Angermann, C., Stork, S., Bauersachs, J., Wanner, C., Frantz, S., for the German Diabetes and Dialysis Study Investi, (2009). Electrocardiography and Outcome in Patients with Diabetes Mellitus on Maintenance Hemodialysis. CJASN 4: 394-400 [Abstract] [Full Text]  
• Andrikopoulos, G., Tzeis, S., Maniadakis, N., Mavrakis, H. E., Vardas, P. E. (2009). Cost-effectiveness of atrial fibrillation catheter ablation. Europace 11: 147-151 [Abstract] [Full Text]  
• Roth, J. A. (2009). Tachycardias: Diagnosis and Management. ACCP Crit Care Med Brd Rev 20: 93-116 [Full Text]  
• Simmons, J. S. (2009). Postoperative Critical Care Management and Selected Postoperative Crises. ACCP Crit Care Med Brd Rev 20: 261-278 [Full Text]  
• Israel, C. W. (2009). Optimizing the treatment of atrial fibrillation: contributions by remote monitoring. Europace 11: 7-8 [Full Text]  
• Camm, A. J., Kirchhof, P., Lip, G. Y.H., Savelieva, I., Ernst, S. (2009). CHAPTER 29 Atrial Fibrillation. ESC Textbook of Cardiovascular Medicine 2: med-9780199566990-chapter-med-9780199566990-chapter [Abstract] [Full Text]  
• Jais, P., Cauchemez, B., Macle, L., Daoud, E., Khairy, P., Subbiah, R., Hocini, M., Extramiana, F., Sacher, F., Bordachar, P., Klein, G., Weerasooriya, R., Clementy, J., Haissaguerre, M. (2008). Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation: The A4 Study. Circulation 118: 2498-2505 [Abstract] [Full Text]  
• Bajpai, A., Savelieva, I., Camm, A. J. (2008). Treatment of atrial fibrillation. Br Med Bull 0: ldn046v1-20 [Abstract] [Full Text]  
• (2008). For questions on page. Emerg. Med. J. 25: 860-860 [Full Text]  
• Okin, P. M., Wachtell, K., Kjeldsen, S. E., Julius, S., Lindholm, L. H., Dahlof, B., Hille, D. A., Nieminen, M. S., Edelman, J. M., Devereux, R. B. (2008). Incidence of Atrial Fibrillation in Relation to Changing Heart Rate Over Time in Hypertensive Patients: The LIFE Study. Circ Arrhythm Electrophysiol 1: 337-343 [Abstract] [Full Text]  
• Sacher, F., Weerasooriya, R., Jais, P. (2008). Atrial fibrillation ablation: beyond electro-mechanical matters: reply. Eur Heart J 29: 2819-2819 [Full Text]  
• Choudhry, N. K, Zagorski, B., Avorn, J., Levin, R., Sykora, K., Laupacis, A., Mamdani, M. (2008). Comparison of the Impact of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management Trial on Prescribing Patterns: A Time-Series Analysis. The Annals of Pharmacotherapy 42: 1563-1572 [Abstract] [Full Text]  
• Khan, M. N., Jais, P., Cummings, J., Di Biase, L., Sanders, P., Martin, D. O., Kautzner, J., Hao, S., Themistoclakis, S., Fanelli, R., Potenza, D., Massaro, R., Wazni, O., Schweikert, R., Saliba, W., Wang, P., Al-Ahmad, A., Beheiry, S., Santarelli, P., Starling, R. C., Russo, A. D., Pelargonio, G., Brachmann, J., Schibgilla, V., Bonso, A., Casella, M., Raviele, A., Haissaguerre, M., Natale, A., the PABA-CHF Investigators, (2008). Pulmonary-Vein Isolation for Atrial Fibrillation in Patients with Heart Failure. NEJM 359: 1778-1785 [Abstract] [Full Text]  
• Ahmed, S., Rienstra, M., Crijns, H. J. G. M., Links, T. P., Wiesfeld, A. C. P., Hillege, H. L., Bosker, H. A., Lok, D. J. A., Van Veldhuisen, D. J., Van Gelder, I. C., for the CONVERT Investigators, (2008). Continuous vs Episodic Prophylactic Treatment With Amiodarone for the Prevention of Atrial Fibrillation: A Randomized Trial. JAMA 300: 1784-1792 [Abstract] [Full Text]  
• Halperin, H. R., Nazarian, S. (2008). Damage Assessment After Ablation: Role of Cardiovascular Magnetic Resonance. J Am Coll Cardiol 52: 1272-1273 [Full Text]  
• Wong, J., Mak, K. (2008). Invited Commentary. Ann. Thorac. Surg. 86: 1217-1218 [Full Text]  
• Blaauw, Y, Crijns, H J G M (2008). Treatment of atrial fibrillation. Heart 94: 1342-1349 [Full Text]  
• Adam, O., Neuberger, H.-R., Bohm, M., Laufs, U. (2008). Prevention of Atrial Fibrillation With 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors. Circulation 118: 1285-1293 [Full Text]  
• Camm, A. J., Reiffel, J. A. (2008). Defining endpoints in clinical trials on atrial fibrillation. Eur Heart J Suppl 10: H55-H78 [Abstract] [Full Text]  
• Aliot, E., Ruskin, J. N. (2008). Controversies in ablation of atrial fibrillation. Eur Heart J Suppl 10: H32-H54 [Abstract] [Full Text]  
• Dorian, P., Singh, B. N. (2008). Upstream therapies to prevent atrial fibrillation. Eur Heart J Suppl 10: H11-H31 [Abstract] [Full Text]  
• Tan, A. Y., Zhou, S., Ogawa, M., Song, J., Chu, M., Li, H., Fishbein, M. C., Lin, S.-F., Chen, L. S., Chen, P.-S. (2008). Neural Mechanisms of Paroxysmal Atrial Fibrillation and Paroxysmal Atrial Tachycardia in Ambulatory Canines. Circulation 118: 916-925 [Abstract] [Full Text]  
• Chaiyaroj, S., Ngarmukos, T., Lertsithichai, P. (2008). Predictors of Sinus Rhythm after Radiofrequency Maze and Mitral Valve Surgery. Asian Cardiovasc. Thorac. Ann. 16: 292-297 [Abstract] [Full Text]  
• Glover, B M, Walsh, S J, McCann, C J, Moore, M J, Manoharan, G, Dalzell, G W N, McAllister, A, McClements, B, McEneaney, D J, Trouton, T G, Mathew, T P, Adgey, A A J (2008). Biphasic energy selection for transthoracic cardioversion of atrial fibrillation. The BEST AF Trial. Heart 94: 884-887 [Abstract] [Full Text]  
• Roy, D., Talajic, M., Nattel, S., Wyse, D. G., Dorian, P., Lee, K. L., Bourassa, M. G., Arnold, J. M. O., Buxton, A. E., Camm, A. J., Connolly, S. J., Dubuc, M., Ducharme, A., Guerra, P. G., Hohnloser, S. H., Lambert, J., Le Heuzey, J.-Y., O'Hara, G., Pedersen, O. D., Rouleau, J.-L., Singh, B. N., Stevenson, L. W., Stevenson, W. G., Thibault, B., Waldo, A. L., the Atrial Fibrillation and Congestive Heart Failu, (2008). Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure. NEJM 358: 2667-2677 [Abstract] [Full Text]  
• Cain, M. E., Curtis, A. B. (2008). Rhythm Control in Atrial Fibrillation -- One Setback after Another. NEJM 358: 2725-2727 [Full Text]  
• Hiatt, W. R., Lincoff, A. M., Harrington, R. A. (2008). Acute Pharmacological Conversion of Atrial Fibrillation to Sinus Rhythm: Is Short-Term Symptomatic Therapy Worth It? A Report From the December 2007 Meeting of the Cardiovascular and Renal Drugs Advisory Committee of the Food and Drug Administration. Circulation 117: 2956-2957 [Full Text]  
• Meiltz, A., Zimmermann, M., Urban, P., Bloch, A., on behalf of the Association of Cardiologists of t, (2008). Atrial fibrillation management by practice cardiologists: a prospective survey on the adherence to guidelines in the real world. Europace 10: 674-680 [Abstract] [Full Text]  
• Singer, D. E., Albers, G. W., Dalen, J. E., Fang, M. C., Go, A. S., Halperin, J. L., Lip, G. Y. H., Manning, W. J. (2008). Antithrombotic Therapy in Atrial Fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133: 546S-592S [Abstract] [Full Text]  
• Salem, D. N., O'Gara, P. T., Madias, C., Pauker, S. G. (2008). Valvular and Structural Heart Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133: 593S-629S [Abstract] [Full Text]  
• Scheinman, M. M., Keung, E. (2008). The Year in Review of Clinical Cardiac Electrophysiology. J Am Coll Cardiol 51: 2075-2081 [Full Text]  
• Lutomsky, B. A., Rostock, T., Koops, A., Steven, D., Mullerleile, K., Servatius, H., Drewitz, I., Ueberschar, D., Plagemann, T., Ventura, R., Meinertz, T., Willems, S. (2008). Catheter ablation of paroxysmal atrial fibrillation improves cardiac function: a prospective study on the impact of atrial fibrillation ablation on left ventricular function assessed by magnetic resonance imaging. Europace 10: 593-599 [Abstract] [Full Text]  
• Thomas, L., Hoy, M., Byth, K., Schiller, N. B. (2008). The left atrial function index: a rhythm independent marker of atrial function. Eur J Echocardiogr 9: 356-362 [Abstract] [Full Text]