FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 347:1834-1840 December 5, 2002 Number 23 Next

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 Maintenance of sinus rhythm is the main therapeutic goal in patients with atrial fibrillation. However, recurrences of atrial fibrillation and side effects of antiarrhythmic drugs offset the benefits of sinus rhythm. We hypothesized that ventricular rate control is not inferior to the maintenance of sinus rhythm for the treatment of atrial fibrillation.

Methods We randomly assigned 522 patients who had persistent atrial fibrillation after a previous electrical cardioversion to receive treatment aimed at rate control or rhythm control. Patients in the rate-control group received oral anticoagulant drugs and rate-slowing medication. Patients in the rhythm-control group underwent serial cardioversions and received antiarrhythmic drugs and oral anticoagulant drugs. The end point was a composite of death from cardiovascular causes, heart failure, thromboembolic complications, bleeding, implantation of a pacemaker, and severe adverse effects of drugs.

Results After a mean (±SD) of 2.3±0.6 years, 39 percent of the 266 patients in the rhythm-control group had sinus rhythm, as compared with 10 percent of the 256 patients in the rate-control group. The primary end point occurred in 44 patients (17.2 percent) in the rate-control group and in 60 (22.6 percent) in the rhythm-control group. The 90 percent (two-sided) upper boundary of the absolute difference in the primary end point was 0.4 percent (the prespecified criterion for noninferiority was 10 percent or less). The distribution of the various components of the primary end point was similar in the rate-control and rhythm-control groups.

Conclusions Rate control is not inferior to rhythm control for the prevention of death and morbidity from cardiovascular causes and may be appropriate therapy in patients with a recurrence of persistent atrial fibrillation after electrical cardioversion.

Methods

Study Design

Thirty-one centers in the Netherlands participated in the study. The institutional review boards at each participating hospital approved the study protocol, and all patients gave written informed consent. The study was conducted from June 1, 1998, until July 1, 2001. The follow-up period was at least two years. The study design is shown in Figure 1.

View larger version (28K): [in this window] [in a new window]   Figure 1. Study Design. With the rate-control strategy, electrical cardioversion was allowed if ventricular rate-controlling drugs were associated with intolerable symptoms. The numbers in parentheses indicate the numbers of patients at the end of follow-up. Eight patients in the rate-control group and nine in the rhythm-control group withdrew from the study early. In the rhythm-control group, a total of 44 patients had atrial fibrillation at the end of follow-up, including 3 with a recurrence within six months. These patients were scheduled for a new cardioversion. Atrial fibrillation was accepted if there was no response to the last cardioversion or if there was a recurrence within six months.

 
Only patients with recurrent persistent atrial fibrillation or flutter, in whom oral anticoagulation was not contraindicated, were included. Persistent atrial fibrillation and flutter were defined as non–self-terminating arrhythmia requiring electrical cardioversion to obtain sinus rhythm.^3,9 Atrial flutter was defined as a supraventricular tachycardia with a regular atrial rhythm between 240 and 430 beats per minute. Patients were excluded if arrhythmia had lasted longer than one year. In addition to the usual exclusion criteria for studies of electrical cardioversion, we also excluded patients with New York Heart Association class IV heart failure, current or previous treatment with amiodarone, or a pacemaker. Patients were required to have undergone one electrical cardioversion during the previous two years, with a maximum of two.

Patients were seen in the outpatient department 1, 3, 6, 12, and 24 months after randomization and at the end of the study. At each visit, any cardiovascular events were recorded, and a 12-lead electrocardiogram was obtained. All events had to be reported on a special form. After documentation of one (nonfatal) end point, follow-up was continued to document additional end points.

Rate control was achieved with the administration of digitalis, a nondihydropyridine calcium-channel blocker, and a beta-blocker, alone or in combination. The target was a resting heart rate of less than 100 beats per minute (monitored with a 12-lead resting electrocardiogram). If patients had intolerable symptoms due to atrial fibrillation, unacceptable adverse effects of the atrioventricular-node–blocking drugs, or progressive left ventricular dysfunction despite treatment (i.e., tachycardia-induced cardiomyopathy), cardioversion or atrioventricular-node ablation and implantation of a pacemaker were performed.

Patients randomly assigned to the rhythm-control group underwent electrical cardioversion without previous treatment with antiarrhythmic drugs. Thereafter, patients received sotalol (160 to 320 mg daily, depending on body weight and renal function). If there was a recurrence within six months, electrical cardioversion was repeated and sotalol was replaced by flecainide (200 to 300 mg daily) or propafenone (450 to 900 mg daily). If there was a recurrence within six months after the start of this regimen, a loading dose of amiodarone was given (600 mg daily for four weeks), and electrical cardioversion was repeated. The dose of amiodarone was then lowered to 200 mg daily. In the case of a recurrence after six months of therapy with an antiarrhythmic drug, the regimen was continued. The administration of sotalol, flecainide, and propafenone was initiated in the hospital with telemetric monitoring. Treatment with amiodarone was started out of the hospital. When these drugs were prescribed, the usual specific restrictions were applied.

From four weeks before until four weeks after electrical cardioversion, all patients received acenocoumarol or fenprocoumon (target international normalized ratio [INR], 2.5 to 3.5). If sinus rhythm was present at one month, the oral anticoagulant could be stopped or changed to aspirin (80 to 100 mg daily). Aspirin was also allowed in patients in the rate-control group who were less than 65 years old if they had atrial fibrillation without underlying cardiac disease. All other patients received oral anticoagulant therapy.^10,11,12

End Points

The primary end point was the composite of death from cardiovascular causes, heart failure, thromboembolic complications, bleeding, the need for implantation of a pacemaker, or severe adverse effects of antiarrhythmic drugs. We recorded all (component) events that occurred between randomization and July 1, 2001, with a maximum of three years of follow-up. All deaths were considered to be due to cardiovascular causes unless an unequivocal noncardiac cause could be identified.

Heart failure was defined as an episode of left or right ventricular failure necessitating hospitalization. Cerebrovascular events had to be diagnosed by a neurologist, and the cause was determined with the use of computed tomography. Peripheral thromboembolism had to be confirmed by a surgeon. Bleeding was recorded as an end point if the hemoglobin value decreased by more than 2 g per liter, if blood transfusion or hospitalization was necessary, or if the bleeding was fatal. Torsade de pointes, unexpected ventricular tachycardia or fibrillation, 1:1 atrioventricular conduction during atrial flutter, third-degree atrioventricular block, the sick sinus syndrome, digitalis intoxication, and drug-induced heart failure were classified as severe adverse effects of antiarrhythmic drugs. A committee of experts who were unaware of the treatment assignments adjudicated all possible end points.

Statistical Analysis

The primary objective was to show the noninferiority of rate control as compared with rhythm control in terms of the incidence of the primary end point. A two-sided 90 percent confidence interval (which provides the same upper limit as the 95 percent one-sided confidence interval) was calculated for the difference between the incidence of the primary end point in the rate-control group and the incidence in the rhythm-control group. The incidence of the primary end point was calculated for all patients, irrespective of whether they actually received the assigned treatment (on the intention-to-treat principle). Noninferiority was considered to be established if the upper boundary of the confidence interval did not exceed 10 percent. We calculated that with a significance level of 5 percent (one-sided), a power of 80 percent, and an assumed 30 percent incidence of the primary end point, 260 patients per group would be required.

Kaplan–Meier estimates were used to determine the occurrence of the primary end point over time. The components of the primary end point are reported as secondary end points. There were no prespecified subgroup analyses. However, the results of post hoc subgroup analyses are presented for descriptive purposes.

Results

Characteristics of the Patients

A total of 522 patients were enrolled in the study: 256 in the rate-control group and 266 in the rhythm-control group (Table 1). The characteristics of the patients were typical of a population of patients with persistent atrial fibrillation.^4,13 Ninety percent of the patients in the rate-control group and 91 percent of those in the rhythm-control group had one or more risk factors for stroke.^10,11,14 The proportion of patients with hypertension was higher in the rhythm-control group than in the rate-control group (P=0.007). There were no other significant differences in clinical characteristics between the two groups.

View this table: [in this window] [in a new window]   Table 1. Characteristics of the Patients According to the Assigned Treatment.

 
Treatment

Patients were followed for a mean (±SD) of 2.3±0.6 years. Figure 1 shows the numbers of patients in the two groups and their treatment at the end of follow-up. In the rhythm-control group, 103 patients (39 percent) had sinus rhythm at the end of the study (97 patients) or at the time of withdrawal from the study (6 patients); 116 (44 percent) had atrial fibrillation at the end of the study, and 47 (18 percent) had atrial fibrillation but were scheduled for cardioversion (44 patients) or had atrial fibrillation at the time of withdrawal (3 patients). Patients underwent a median of 2 electrical cardioversions (range, 0 to 7). In the rate-control group, 26 patients (10 percent) had sinus rhythm at the end of the study; half of them had undergone electrical cardioversion because of intolerable symptoms and half had undergone spontaneous conversion.

The mean heart rate in the resting state was significantly lower during rhythm control (73±18 beats per minute) than during rate control (82±16 beats per minute); this difference was related to the presence of sinus rhythm (mean heart rate, 66±14 beats per minute) or atrial fibrillation (mean heart rate, 85±17 beats per minute) rather than to the treatment assignment. The number of patients who received oral anticoagulant therapy during follow-up ranged from 246 (96 percent) to 254 (99 percent) in the rate-control group and from 228 (86 percent) to 263 (99 percent) in the rhythm-control group.

Outcome

The primary end point occurred in 44 of the 256 patients in the rate-control group (17.2 percent) and in 60 of the 266 patients in the rhythm-control group (22.6 percent) (Table 2). The absolute difference of –5.4 percent represents a trend in favor of rate control. The 90 percent confidence interval of –11.0 to 0.4 percent confirmed that rate control met the criterion for noninferiority (absolute difference, 10 percent or less) and approached that for superiority. The noninferiority of rate control as compared with rhythm control was confirmed in an ancillary analysis with statistical adjustment for the unbalanced distribution of patients with hypertension between the two groups; the adjusted absolute difference was –4.2 percent, and the corresponding 90 percent confidence interval was –10.0 to 1.5 percent.

View this table: [in this window] [in a new window]   Table 2. Incidence of the Primary End Point and Its Components According to the Treatment Group.

 
Kaplan–Meier estimates of the first occurrence of the primary end point over time are shown in Figure 2. The hazard ratio for the risk of the primary end point in the rate-control group, as compared with the rhythm-control group, was 0.73 (90 percent confidence interval, 0.53 to 1.01; P=0.11). Table 2 shows the incidence of the components of the primary end point. The rate of death from cardiovascular causes was similar in the two groups: 7.0 percent in the rate-control group and 6.8 percent in the rhythm-control group. The causes of death were cerebral or retroperitoneal bleeding in six patients in the rate-control group and three patients in the rhythm-control group, heart failure in four patients in the rate-control group and one patient in the rhythm-control group, and thromboembolism (stroke) in six patients in the rhythm-control group. Eight patients in each group died suddenly; 2 of the 16 were taking amiodarone, 1 was taking sotalol, and 1 was taking flecainide. At the time of the occurrence of the primary end point, 29 patients (28 percent) had sinus rhythm, and 75 patients (72 percent) had atrial fibrillation.

View larger version (12K): [in this window] [in a new window]   Figure 2. Kaplan–Meier Curves for Event-free Survival in the Rate-Control and Rhythm-Control Groups.

 
Thromboembolic complications occurred in 35 patients, all of whom had risk factors for stroke. Thromboembolism was more frequent in the rhythm-control group than in the rate-control group. Six patients, all in the rhythm-control group, had thromboembolic complications after the cessation of oral anticoagulant therapy; five of them had sinus rhythm. Twenty-three patients had thromboembolic complications while receiving inadequate anticoagulant therapy (INR, less than 2.0). The majority of patients with thromboembolic events (73 percent) had atrial fibrillation at the time of the event. Twenty of the 21 episodes of bleeding occurred during oral anticoagulant therapy. In 17 patients, bleeding occurred while the INR was greater than 3.

Severe adverse effects of antiarrhythmic drugs occurred mainly in the rhythm-control group: seven patients had the sick sinus syndrome or atrioventricular block; three had torsade de pointes or ventricular fibrillation; one had rapid, hemodynamically significant atrioventricular conduction during flutter; and one had drug-induced heart failure. The four patients who died suddenly while taking antiarrhythmic drugs were not counted separately, since it could not be proved that the death was related to the drug. In the rate-control group, there were only two patients with nonlethal digitalis intoxication. A pacemaker was implanted in three patients in the rate-control group (after atrioventricular-node ablation) and in eight patients in the rhythm-control group (for bradycardia during atrial fibrillation in one, after atrioventricular-node ablation in two, and for the sick sinus syndrome unmasked by cardioversion in five).

Table 3 shows the incidence of the primary end point according to sex and blood-pressure status. Among women and patients with hypertension, the incidence of the primary end point was higher with rhythm control than with rate control.

View this table: [in this window] [in a new window]   Table 3. Incidence of the Primary End Point According to Sex and Blood-Pressure Status.

 
Post hoc analysis showed that in the rhythm-control group, the incidence of the components of the primary end point did not differ significantly according to whether the patient had sinus rhythm or atrial fibrillation at the end of follow-up. In both the rate-control group and the rhythm-control group, a primary end point occurred in 5 of 18 patients with atrial flutter (27.8 percent).

Discussion

Our results show that rate control is an acceptable alternative to rhythm control in patients with recurrent persistent atrial fibrillation. The two strategies were associated with a considerable but similar number of major cardiovascular events. However, events were particularly frequent with rhythm control, especially in patients who had hypertension and in women. These findings substantiate the noninferiority of rate control. Rate control should therefore be considered much earlier in the course of managing recurrent persistent atrial fibrillation than it is with current approaches.

Why was rhythm control not associated with fewer cardiovascular events than rate control? At the end of follow-up, only 39 percent of the patients in the rhythm-control group had sinus rhythm, despite a careful treatment protocol. Obviously, safer and more effective methods of maintaining sinus rhythm are needed, and such methods may help reduce morbidity in the future. However, effective preservation of sinus rhythm does not preclude the occurrence of cardiovascular events. We found that among the patients treated with rhythm control, morbidity and mortality were similar whether sinus rhythm was maintained or atrial fibrillation recurred. This finding suggests that the cardiovascular risk is not reduced with rhythm control even when sinus rhythm is maintained.

Several factors may account for the lack of a reduction in risk with rhythm control. First, although sinus rhythm is believed to prevent tachycardia-induced cardiomyopathy and heart failure, effective rate control may also prevent heart failure, thereby offsetting the relative benefits of rhythm control.^15,16 This is demonstrated by our finding that the incidence of heart failure was similar with the two treatments.

Second, although maintaining sinus rhythm is generally believed to reduce the risk of stroke, patients with risk factors may have a stroke after the cessation of anticoagulant therapy, despite the maintenance of sinus rhythm.^3,17 Our data strongly support this notion. The study protocol allowed the cessation of anticoagulant therapy after sinus rhythm had been maintained for at least one month. Six thromboembolic events (17.1 percent of the total number) occurred after the cessation of anticoagulant therapy, and in all but one case, the patient was still in sinus rhythm at the time of the event.

Third, rhythm control may reduce the risk of bleeding related to the discontinuation of anticoagulant therapy. In our study, even though anticoagulant therapy could be stopped once long-term sinus rhythm had been achieved, the rate of use of such therapy was similar in the two treatment groups, and consequently, the incidence of bleeding was similar. Our findings also suggest that almost all patients with persistent atrial fibrillation have one or more risk factors for stroke. Therefore, anticoagulant therapy can be stopped only rarely. Consequently, the risk of bleeding will not be reduced by rhythm control.

Fourth, with rhythm control but not rate control, electrical cardioversion, especially in combination with the use of prophylactic drugs, may unmask the sick sinus syndrome or atrioventricular conduction disturbances and lead to the implantation of a pacemaker, as it did in five patients in our rhythm-control group. Likewise, the use of prophylactic antiarrhythmic drugs contributed significantly to the incidence of major cardiac end points in the rhythm-control group but not in the rate-control group.

Thromboembolic events were frequent in our study because of the high prevalence of risk factors for stroke.^10,11,14 However, the number of events was surprisingly high, since an effort was made to maintain the INR in the range of 2.5 and 3.5, which is even higher than the currently recommended target range of 2.0 to 3.0.³ Most strokes occurred at an INR below 2.0. Likewise, most bleeding episodes occurred at an INR that exceeded 3.0. These results demonstrate that intermittently inadequate or excessive levels of anticoagulant therapy may be harmful in a substantial number of patients with atrial fibrillation.

There were remarkable differences in the incidence of primary end-point events when the results were analyzed according to blood-pressure status or sex (Table 3). Hypertension and female sex were associated with a higher incidence of an event in the rhythm-control group. These findings suggest that rhythm-control treatment with the use of repeated cardioversion should not be encouraged in patients with hypertension or in women with recurrent persistent atrial fibrillation and that atrial fibrillation can be accepted as the predominant rhythm early in the course of treatment. Since these subgroup analyses were not prespecified, however, the results are useful only for generating hypotheses.

Is there still a place for rhythm control? It should be noted that we included only patients who had a recurrence of atrial fibrillation after at least one previous cardioversion. Therefore, our conclusion that rate control is an acceptable alternative to rhythm control does not necessarily apply to patients seen for the first time with atrial fibrillation. In particular, rhythm control may be indicated in patients with serious symptoms of atrial fibrillation. Rather than rate control, cardioversion in combination with prophylactic drugs is one of the first options in such patients.

Supported by grants from the Center for Health Care Insurance (OG96-047) and the Interuniversity Cardiology Institute, the Netherlands, and by an unrestricted grant from 3M Pharma, the Netherlands.

Drs. Van Gelder and Crijns have reported receiving lecture fees from 3M Pharma. Dr. Crijns has reported serving as a consultant to Sanofi–Synthelabo and AstraZeneca.

We are indebted to Dr. Hein Wellens for his careful review of the manuscript and his helpful suggestions.

^* The participants in the Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study Group are listed in the Appendix.

Source Information

From the Department of Cardiology (I.C.V.G., V.E.H., H.J.G.M.C.) and the Trial Coordination Center (T.K.), University Hospital, Groningen; Rijnstate Hospital, Arnhem (H.A.B.); St. Antonius Hospital, Nieuwegein (J.H.K.); Free University Medical Center, Amsterdam (O.K.); Hospital Midden-Twente, Hengelo (S.A.S.); Twenteborg Hospital, Almelo (J.I.D.); Medisch Spectrum Twente, Enschede (A.J.M.T.); and Academic Medical Center, Amsterdam (J.G.P.T.) — all in the Netherlands.

Address reprint requests to Dr. Van Gelder at the Department of Cardiology, Thoraxcenter, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands, or at i.c.van.gelder{at}thorax.azg.nl.

References

1. Wellens HJJ. Atrial fibrillation -- the last big hurdle in treating supraventricular tachycardia. N Engl J Med 1994;331:944-945. [Free Full Text]
2. Falk RH. Atrial fibrillation. N Engl J Med 2001;344:1067-1078. [Erratum, N Engl J Med 2001;344:1876.] [Free Full Text]
3. 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 of Pacing and Electrophysiology. Circulation 2001;104:2118-2150. [Free Full Text]
4. Van Gelder IC, Crijns HJGM, Tieleman RG, et al. Chronic atrial fibrillation: success of serial cardioversion therapy and safety of oral anticoagulation. Arch Intern Med 1996;156:2585-2592. [Abstract]
5. Coplen SE, Antman EM, Berlin JA, Hewitt P, Chalmers TC. Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion: a meta-analysis of randomized control trials. Circulation 1990;82:1106-1116. [Erratum, Circulation 1991;83:74.] [Free Full Text]
6. Hohnloser SH, Singh BN. Proarrhythmia with class III antiarrhythmic drugs: definition, electrophysiologic mechanism, incidence, predisposing factors, and clinical implications. J Cardiovasc Electrophysiol 1995;6:920-936. [ISI][Medline]
7. 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][ISI][Medline]
8. Hohnloser SH, Kuck KH, Lilienthal J. Rhythm or rate control in atrial fibrillation -- Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet 2000;356:1789-1794. [CrossRef][ISI][Medline]
9. Gallagher MM, Camm J. Classification of atrial fibrillation. Am J Cardiol 1998;82:18N-28N. [CrossRef][ISI][Medline]
10. The Stroke Prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation. I. Clinical features of patients at risk. Ann Intern Med 1992;116:1-5. [ISI][Medline]
11. The Stroke Prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation. II. Echocardiographic features of patients at risk. Ann Intern Med 1992;116:6-12. [ISI][Medline]
12. Hart RG, Pearce LA, McBride R, Rothbart RM, Asinger RW. Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation: analysis of 2012 participants in the SPAF I-III clinical trials. Stroke 1999;30:1223-1229. [Free Full Text]
13. Levy S, Maarek M, Coumel P, et al. Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study. Circulation 1999;99:3028-3035. [Free Full Text]
14. 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]
15. Packer DL, Bardy GH, Worley SJ, et al. Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am J Cardiol 1986;57:563-570. [CrossRef][ISI][Medline]
16. Grogan M, Smith HC, Gersh BJ, Wood DL. Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy. Am J Cardiol 1992;69:1570-1573. [CrossRef][ISI][Medline]
17. Hart RG, Pearce LA, Rothbart RM, McAnulty JH, Asinger RW, Halperin JL. Stroke with intermittent atrial fibrillation: incidence and predictors during aspirin therapy. J Am Coll Cardiol 2000;35:183-187. [Free Full Text]

The following persons participated in the Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study (the numbers in parentheses indicate the numbers of patients enrolled): University Hospital, Groningen — H. Crijns, I. Van Gelder, V. Hagens, T. Kingma (74); St. Antonius Hospital, Nieuwegein — J. Lindeboom, J. Kingma (36); Hospital Midden-Twente, Hengelo — S. Said (34); Rijnstate Hospital, Arnhem — H. Bosker (31); Medisch Spectrum Twente Hospital, Enschede — A. Timmermans (31); Twenteborg Hospital, Almelo — J. Darmanata, G. Linssen, B. de Rode (30); Ignatius Hospital, Breda — R. Wielinga (24); Isala Hospital, Zwolle — A. van 't Hof, M. Vet (24); Oosterschelde Hospital, Goes — E. Bruyns, A. Liem (22); Free University Medical Center, Amsterdam — M. Mihciokur, O. Kamp (21); Stichting Deventer Hospitals, Deventer — E. Badings, D. Lok (20); Canisius Wilhelmina Hospital, Nijmegen — D. Hertzberger (19); St. Lucas Hospital, Winschoten — T. Bouwmeester, A. van der Galiën (18); Catharina Hospital, Eindhoven — A. Meyer, F. Bracke (11); Scheper Hospital, Emmen — M. Nagelsmit (11); Onze Lieve Vrouwe Hospital, Amsterdam — T. Slagboom (9); Hospital Hilversum, Hilversum — K. Liem (9); Antonius Hospital, Sneek — B. Cernohorsky (9); Reinier de Graaf Hospital, Delft — D. Rehorst, A. Withagen (8); Bosch Medicentrum Hospital, Den Bosch — H. Dohmen (8); Martini Hospital, Groningen — P. Bernink, M. Niemeijer, J. Posma (8); Hospital de Tjongerschans, Heerenveen — S. Oei, J. van Os, G. Jochemsen (8); Hospital Medisch Centrum, Leeuwarden — R. Breedveld, W. Schenkel, C. de Vries (8); University Hospital, Maastricht — C. Kirchhof (8); Haven Hospital, Rotterdam — C. Leenders (7); de Honte Hospital, Terneuzen — R. Ciampricotti, R. Taverne, G. Paulussen (6); Albert Schweitzer Hospital, Dordrecht — P. Breuls (5); Ikazia Hospital, Rotterdam — J. Kerker (5); Hospital Refaja, Stadskanaal — L. Van Wijk (3); St. Elisabeth Hospital, Tilburg — W. Pasteuning, N. Holwerda (3); Albert Schweitzer Hospital, Zwijndrecht — A. Herweijer (3); Delfzicht Hospital, Delfzijl — J. Spanjaard (3); University Hospital, Nijmegen — F. Verheugt (2); Hospital de Sionsberg, Dokkum — A. Hagoort-Kok, E. van den Toren (2); Schieland Hospital, Schiedam — H. Werner, H. Spierenburg (2); Policy Advisory Board — H. Wellens, K. Lie, N. Van Hemel; End Point Committee — J. Van Der Meer, J. Viersma, M. Van De Linde, A. De Jager; Steering Committee — H. Crijns, I. Van Gelder, H. Bosker, O. Kamp, J. Kingma, J. Tijssen.

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

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.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:1284-1286, Mar 27, 2003. Correspondence

This article has been cited by other articles:

• 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]  
• 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]  
• Kleemann, T., Becker, T., Strauss, M., Schneider, S., Seidl, K. (2008). 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 0: jen256v1-6 [Abstract] [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]  
• Dorian, P., Singh, B. N. (2008). Upstream therapies to prevent atrial fibrillation. Eur Heart J Suppl 10: H11-H31 [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]  
• 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]  
• Buck, S., Rienstra, M., Maass, A. H., Nieuwland, W., Van Veldhuisen, D. J., Van Gelder, I. C. (2008). Cardiac resynchronization therapy in patients with heart failure and atrial fibrillation: importance of new-onset atrial fibrillation and total atrial conduction time. Europace 10: 558-565 [Abstract] [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]  
• Au, D. H (2008). Use of {beta} blockers in patients with COPD. Thorax 63: 296-298 [Full Text]  
• Hansen, M. L., Gadsboll, N., Gislason, G. H., Abildstrom, S. Z., Schramm, T. K., Folke, F., Friberg, J., Sorensen, R., Rasmussen, S., Poulsen, H. E., Kober, L., Madsen, M., Torp-Pedersen, C. (2008). Atrial fibrillation pharmacotherapy after hospital discharge between 1995 and 2004: a shift towards beta-blockers. Europace 10: 395-402 [Abstract] [Full Text]  
• Tan, E. S., Rienstra, M., Wiesfeld, A. C.P., Schoonderwoerd, B. A., Hobbel, H. H.F., Van Gelder, I. C. (2008). Long-term outcome of the atrioventricular node ablation and pacemaker implantation for symptomatic refractory atrial fibrillation. Europace 10: 412-418 [Abstract] [Full Text]  
• Noheria, A., Kumar, A., Wylie, J. V. Jr, Josephson, M. E. (2008). Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation: A Systematic Review. Arch Intern Med 168: 581-586 [Abstract] [Full Text]  
• Soran, H., Younis, N., Currie, P., Silas, J., Jones, I.R., Gill, G. (2008). Influence of diabetes on the maintenance of sinus rhythm after a successful direct current cardioversion in patients with atrial fibrillation. QJM 101: 181-187 [Abstract] [Full Text]  
• Hemels, M. E.W., Ruiter, J. H., Molhoek, G. P., Veeger, N. J.G.M., Wiesfeld, A. C.P., Ranchor, A. V., van Trigt, M., Pilmeyer, A., Van Gelder, I. C., for The Features in AT500TM study; Chances for pat, (2008). Right atrial preventive and antitachycardia pacing for prevention of paroxysmal atrial fibrillation in patients without bradycardia: a randomized study. Europace 10: 306-313 [Abstract] [Full Text]  
• Nademanee, K., Schwab, M. C., Kosar, E. M., Karwecki, M., Moran, M. D., Visessook, N., Michael, A. D., Ngarmukos, T. (2008). Clinical Outcomes of Catheter Substrate Ablation for High-Risk Patients With Atrial Fibrillation. J Am Coll Cardiol 51: 843-849 [Abstract] [Full Text]  
• Arriagada, G., Berruezo, A., Mont, L., Tamborero, D., Molina, I., Coll-Vinent, B., Vidal, B., Sitges, M., Berne, P., Brugada, J., on behalf of the GIRAFA (Grup Integrat de Recerca, (2008). Predictors of arrhythmia recurrence in patients with lone atrial fibrillation. Europace 10: 9-14 [Abstract] [Full Text]  
• Voeller, R. K., Schuessler, R. B., Damiano, R. J. Jr. (2008). Surgical Treatment of Atrial Fibrillation. Card Surg Adult 3: 1375-1394 [Full Text]  
• Cosio, F. G., Aliot, E., Botto, G. L., Heidbuchel, H., Geller, C. J., Kirchhof, P., De Haro, J.-C., Frank, R., Villacastin, J. P., Vijgen, J., Crijns, H. (2008). Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode. Europace 10: 21-27 [Abstract] [Full Text]  
• Padeletti, L., Pieragnoli, P., Jentzen, V., Schuchert, A. (2007). The comorbidity of atrial fibrillation and heart failure: a challenge for electrical therapies. Eur Heart J Suppl 9: I81-I86 [Abstract] [Full Text]  
• Kirchhof, P., Auricchio, A., Bax, J., Crijns, H., Camm, J., Diener, H.-C., Goette, A., Hindricks, G., Hohnloser, S., Kappenberger, L., Kuck, K.-H., Lip, G. Y.H., Olsson, B., Meinertz, T., Priori, S., Ravens, U., Steinbeck, G., Svernhage, E., Tijssen, J., Vincent, A., Breithardt, G. (2007). Outcome parameters for trials in atrial fibrillation: executive summary: Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eur Heart J 28: 2803-2817 [Abstract] [Full Text]  
• Lamotte, M., Annemans, L., Bridgewater, B., Kendall, S., Siebert, M. (2007). A health economic evaluation of concomitant surgical ablation for atrial fibrillation. Eur. J. Cardiothorac. Surg. 32: 702-710 [Abstract] [Full Text]  
• Neuberger, H.-R., Mewis, C., van Veldhuisen, D. J., Schotten, U., van Gelder, I. C., Allessie, M. A., Bohm, M. (2007). Management of atrial fibrillation in patients with heart failure. Eur Heart J 28: 2568-2577 [Abstract] [Full Text]  
• Kirchhof, P., Auricchio, A., Bax, J., Crijns, H., Camm, J., Diener, H.-C., Goette, A., Hindricks, G., Hohnloser, S., Kappenberger, L., Kuck, K.-H., Lip, G. Y.H., Olsson, B., Meinertz, T., Priori, S., Ravens, U., Steinbeck, G., Svernhage, E., Tijssen, J., Vincent, A., Breithardt, G. (2007). Outcome parameters for trials in atrial fibrillation: Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork and the European Heart Rhythm Association. Europace 9: 1006-1023 [Abstract] [Full Text]  
• Alegret, J. M., Vinolas, X., Sagrista, J., Hernandez-Madrid, A., Perez, L., Sabate, X., Mont, L., Medina, A., on behalf of the REVERSE Study Investigators, (2007). Predictors of success and effect of biphasic energy on electrical cardioversion in patients with persistent atrial fibrillation. Europace 9: 942-946 [Abstract] [Full Text]  
• Singh, B. N., Connolly, S. J., Crijns, H. J.G.M., Roy, D., Kowey, P. R., Capucci, A., Radzik, D., Aliot, E. M., Hohnloser, S. H., the EURIDIS and ADONIS Investigators, (2007). Dronedarone for Maintenance of Sinus Rhythm in Atrial Fibrillation or Flutter. NEJM 357: 987-999 [Abstract] [Full Text]  
• Ezekowitz, M. D. (2007). Maintaining Sinus Rhythm -- Making Treatment Better Than the Disease. NEJM 357: 1039-1041 [Full Text]  
• Habara, S., Dote, K., Kato, M., Sasaki, S., Goto, K., Takemoto, H., Hasegawa, D., Matsuda, O. (2007). Prediction of left atrial appendage thrombi in non-valvular atrial fibrillation. Eur Heart J 28: 2217-2222 [Abstract] [Full Text]  
• Jais, P., Packer, D. L. (2007). Ablation vs. drug use for atrial fibrillation. Eur Heart J Suppl 9: G26-G34 [Abstract] [Full Text]  
• Essebag, V., Reynolds, M. R., Hadjis, T., Lemery, R., Olshansky, B., Buxton, A. E., Josephson, M. E., Zimetbaum, P. (2007). Sex Differences in the Relationship Between Amiodarone Use and the Need for Permanent Pacing in Patients With Atrial Fibrillation. Arch Intern Med 167: 1648-1653 [Abstract] [Full Text]  
• Ruchat, P., Dang, L., Schlaepfer, J., Virag, N., von Segesser, L. K., Kappenberger, L. (2007). Use of a biophysical model of atrial fibrillation in the interpretation of the outcome of surgical ablation procedures. Eur. J. Cardiothorac. Surg. 32: 90-95 [Abstract] [Full Text]  
• Rehman, H. u., Kurnik, D., Loebstein, R., Olchovsky, D., Coceani, M., Skolnik, N., Armon, C., Zimetbaum, P. (2007). Amiodarone for Atrial Fibrillation. NEJM 356: 2424-2426 [Full Text]  
• Calkins, H., Brugada, J., Packer, D. L., Cappato, R., Chen, S.-A., Crijns, H. J.G., Damiano, R. J. Jr, Davies, D. W., Haines, D. E., Haissaguerre, M., Iesaka, Y., Jackman, W., Jais, P., Kottkamp, H., Kuck, K. H., Lindsay, B. D., Marchlinski, F. E., McCarthy, P. M., Mont, J. L., Morady, F., Nademanee, K., Natale, A., Pappone, C., Prystowsky, E., Raviele, A., Ruskin, J. N., Shemin, R. J., TASK FORCE MEMBERS, , Calkins, H., Brugada, J., Section Chairs, , Atrial Fibrillation: Definitions, Mechanisms, and, , Chen, S.-A., Indications for Ablation and Patient Selection, , Prystowsky, E. N., Techniques and Endpoints for Atrial Fibrillation, , Kuck, K. H., Technologies and Tools, , Natale, A., Other Technical Aspects, , Haines, D. E., Follow-up Considerations, , Marchlinski, F. E., Outcomes and Efficacy of Catheter Ablation of Atri, , Calkins, H., Complications of Atrial Fibrillation Ablation, , Davies, D. W., Training Requirements and Competencies, , Lindsay, B. D., Surgical Ablation of Atrial Fibrillation, , McCarthy, P. M., Clinical Trial Considerations, , Packer, D. L., Co-Authors, , Cappato, R., Crijns, H. J.G., Damiano, R. J. Jr, Haissaguerre, M., Jackman, W. M., Jais, P., Iesaka, Y., Kottkamp, H., Mont, L., Morady, F., Nademanee, K., Pappone, C., Raviele, A., Ruskin, J. N., Shemin, R. J. (2007). HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society.. Europace 9: 335-379 [Full Text]  
• Gupta, D., Earley, M. J, Haywood, G. A, Richmond, L., Fitzgerald, M., Kojodjojo, P., Sporton, S. C, Peters, N. S, Broadhurst, P., Schilling, R. J, Coarse AF Investigators, (2007). Can atrial fibrillation with a coarse electrocardiographic appearance be treated with catheter ablation of the tricuspid valve-inferior vena cava isthmus? Results of a multicentre randomised controlled trial. Heart 93: 688-693 [Abstract] [Full Text]  
• Murphy, N. F, Simpson, C. R, Jhund, P. S, Stewart, S., Kirkpatrick, M., Chalmers, J., MacIntyre, K., McMurray, J. J V (2007). A national survey of the prevalence, incidence, primary care burden and treatment of atrial fibrillation in Scotland. Heart 93: 606-612 [Abstract] [Full Text]  
• Doty, J. R., Doty, D. B., Jones, K. W., Flores, J. H., Mensah, M., Reid, B. B., Clayson, S. E., Snow, G., Righter, E., Millar, R. C. (2007). Comparison of standard Maze III and radiofrequency Maze operations for treatment of atrial fibrillation. J. Thorac. Cardiovasc. Surg. 133: 1037-1044 [Abstract] [Full Text]  
• Hemels, M. E.W., Wiesfeld, A. C.P., Van Veldhuisen, D. J., Van den Berg, M. P., Van Gelder, I. C. (2007). Outcome of pharmacological rhythm control for new-onset persistent atrial fibrillation in patients with systolic heart failure: a comparison with patients with normal left ventricular function. Europace 9: 239-245 [Abstract] [Full Text]  
• Van Gelder, I. C. (2007). Rhythm control for atrial fibrillation: Non-channel antiarrhythmic drugs are en vogue. Cardiovasc Res 74: 8-10 [Full Text]  
• Rienstra, M., Van Veldhuisen, D. J., Crijns, H. J.G.M., Van Gelder, I. C., for the RACE investigators, (2007). Enhanced cardiovascular morbidity and mortality during rhythm control treatment in persistent atrial fibrillation in hypertensives: data of the RACE study. Eur Heart J 28: 741-751 [Abstract] [Full Text]  
• Onorati, F., Bilotta, M., Borrello, F., Vatrano, M., di Virgilio, A., Comi, M. C., Perticone, F., Renzulli, A. (2007). Successful radiofrequency ablation determines atrio-ventricular remodelling and improves systo-diastolic function at tissue Doppler-imaging. Eur. J. Cardiothorac. Surg. 31: 414-422 [Abstract] [Full Text]  
• Zimetbaum, P. (2007). Amiodarone for Atrial Fibrillation. NEJM 356: 935-941 [Full Text]  
• Shemin, R. J., Cox, J. L., Gillinov, A. M., Blackstone, E. H., Bridges, C. R. (2007). Guidelines for Reporting Data and Outcomes for the Surgical Treatment of Atrial Fibrillation. Ann. Thorac. Surg. 83: 1225-1230 [Abstract] [Full Text]  
• Bertaglia, E., Stabile, G., Senatore, G., Colella, A., Del Greco, M., Goessinger, H., Lamberti, F., Lowe, M., Mantovan, R., Peters, N., Pratola, C., Raatikainen, P., Turco, P., Verlato, R. (2007). A clinical and health-economic evaluation of pulmonary vein encircling ablation compared with antiarrhythmic drug treatment in patients with persistent atrial fibrillation (Catheter Ablation for the Cure of Atrial Fibrillation-2 study). Europace 9: 182-185 [Abstract] [Full Text]  
• Sherman, D. G. (2007). Stroke Prevention in Atrial Fibrillation: Pharmacological Rate Versus Rhythm Control. Stroke 38: 615-617 [Abstract] [Full Text]  
• Das, A. K., Willcoxson, P. D., Corrado, O. J., West, R. M. (2007). The impact of long-term warfarin on the quality of life of elderly people with atrial fibrillation. Age Ageing 36: 95-97 [Full Text]  
• Camm, A J, Savelieva, I, Lip, G Y H, on behalf of the Guideline Development Group for t, (2007). Rate control in the medical management of atrial fibrillation. Heart 93: 35-38 [Full Text]  
• Dzau, V. J., Antman, E. M., Black, H. R., Hayes, D. L., Manson, J. E., Plutzky, J., Popma, J. J., Stevenson, W. (2006). The Cardiovascular Disease Continuum Validated: Clinical Evidence of Improved Patient Outcomes: Part II: Clinical Trial Evidence (Acute Coronary Syndromes Through Renal Disease) and Future Directions. Circulation 114: 2871-2891 [Full Text]  
• Brundel, B. J. J. M., Shiroshita-Takeshita, A., Qi, X., Yeh, Y.-H., Chartier, D., van Gelder, I. C., Henning, R. H., Kampinga, H. H., Nattel, S. (2006). Induction of Heat Shock Response Protects the Heart Against Atrial Fibrillation. Circ. Res. 99: 1394-1402 [Abstract] [Full Text]  
• Bollmann, A., Husser, D., Mainardi, L., Lombardi, F., Langley, P., Murray, A., Rieta, J. J., Millet, J., Olsson, S. B., Stridh, M., Sornmo, L. (2006). Analysis of surface electrocardiograms in atrial fibrillation: techniques, research, and clinical applications.. Europace 8: 911-926 [Abstract] [Full Text]  
• Van Gelder, I. C., Wyse, D. G., Chandler, M. L., Cooper, H. A., Olshansky, B., Hagens, V. E., Crijns, H. J.G.M., the RACE, , AFFIRM Investigators, (2006). Does intensity of rate-control influence outcome in atrial fibrillation? An analysis of pooled data from the RACE and AFFIRM studies. Europace 8: 935-942 [Abstract] [Full Text]  
• Van Gelder, I. C., Hemels, M. E.W. (2006). The progressive nature of atrial fibrillation: a rationale for early restoration and maintenance of sinus rhythm. Europace 8: 943-949 [Abstract] [Full Text]  
• Lombardo, R. M.R., Reina, C., Abrignani, M. G., Braschi, A., De Castro, S. (2006). Embolic stroke, sinus rhythm and left atrial mechanical function. Eur J Echocardiogr 7: 401-404 [Abstract] [Full Text]  
• Okin, P. M., Wachtell, K., Devereux, R. B., Harris, K. E., Jern, S., Kjeldsen, S. E., Julius, S., Lindholm, L. H., Nieminen, M. S., Edelman, J. M., Hille, D. A., Dahlof, B. (2006). Regression of electrocardiographic left ventricular hypertrophy and decreased incidence of new-onset atrial fibrillation in patients with hypertension.. JAMA 296: 1242-1248 [Abstract] [Full Text]  
• Hemels, M. E.W., Van Noord, T., Crijns, H. J.G.M., Van Veldhuisen, D. J., Veeger, N. J.G.M., Bosker, H. A., Wiesfeld, A. C.P., Van den Berg, M. P., Ranchor, A. V., Van Gelder, I. C. (2006). Verapamil Versus Digoxin and Acute Versus Routine Serial Cardioversion for the Improvement of Rhythm Control for Persistent Atrial Fibrillation. J Am Coll Cardiol 48: 1001-1009 [Abstract] [Full Text]  
• Holmqvist, F., Stridh, M., Waktare, J. E.P., Sornmo, L., Olsson, S. B., Meurling, C. J. (2006). Atrial fibrillatory rate and sinus rhythm maintenance in patients undergoing cardioversion of persistent atrial fibrillation. Eur Heart J 27: 2201-2207 [Abstract] [Full Text]  
• Lombardi, F., Borggrefe, M., Ruzyllo, W., Luderitz, B., for the A-COMET-II Investigators, (2006). Azimilide vs. placebo and sotalol for persistent atrial fibrillation: the A-COMET-II (Azimilide-CardiOversion MaintEnance Trial-II) trial. Eur Heart J 27: 2224-2231 [Abstract] [Full Text]  
• Writing Committee Members, , Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S., ACC/AHA Task Force Members, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Halperin, J. L., Hunt, S. A., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., ESC Committee for Practice Guidelines, , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L. (2006). ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: 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 (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace 8: 651-745 [Full Text]  
• Nergardh, A, Frick, M (2006). Perceived heart rhythm in relation to ECG findings after direct current cardioversion of atrial fibrillation. Heart 92: 1244-1247 [Abstract] [Full Text]  
• Betts, T R (2006). Rhythm control strategies for "symptomatic" persistent atrial fibrillation: is achieving sinus rhythm enough?. Heart 92: 1189-1190 [Abstract] [Full Text]  
• Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S. (2006). ACC/AHA/ESC 2006 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 (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society . J Am Coll Cardiol 48: 854-906 [Full Text]  
• Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S. (2006). ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: 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 (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society . J Am Coll Cardiol 48: e149-e246 [Full Text]  
• Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S., ACC/AHA TASK FORCE MEMBERS, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Halperin, J. L., Hunt, S. A., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., ESC COMMITTEE FOR PRACTICE GUIDELINES, , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L. (2006). ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: 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 (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114: e257-e354 [Full Text]  
• Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S., ACC/AHA TASK FORCE MEMBERS, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Halperin, J. L., Hunt, S. A., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., ESC COMMITTEE FOR PRACTICE GUIDELINES, , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L. (2006). ACC/AHA/ESC 2006 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 (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114: 700-752 [Full Text]  
• Authors/Task Force Members, , Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S., ESC Committee for Practice Guidelines, , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L., ACC/AHA (Practice Guidelines) Task Force Members, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Halperin, J. L., Hunt, S. A., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B. (2006). ACC/AHA/ESC 2006 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 (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur Heart J 27: 1979-2030 [Full Text]  
• Stulak, J. M., Dearani, J. A., Daly, R. C., Zehr, K. J., Sundt, T. M. III, Schaff, H. V. (2006). Left Ventricular Dysfunction in Atrial Fibrillation: Restoration of Sinus Rhythm by the Cox-Maze Procedure Significantly Improves Systolic Function and Functional Status. Ann. Thorac. Surg. 82: 494-501 [Abstract] [Full Text]  
• Kollar, A., Lick, S. D., Vasquez, K. N., Conti, V. R. (2006). Relationship of Atrial Fibrillation and Stroke After Coronary Artery Bypass Graft Surgery: When is Anticoagulation Indicated?. Ann. Thorac. Surg. 82: 515-523 [Abstract] [Full Text]  
• Holmqvist, F., Stridh, M., Waktare, J. E.P., Roijer, A., Sornmo, L., Platonov, P. G., Meurling, C. J. (2006). Atrial fibrillation signal organization predicts sinus rhythm maintenance in patients undergoing cardioversion of atrial fibrillation. Europace 8: 559-565 [Abstract] [Full Text]  
• Hu, C L, Jiang, H, Tang, Q Z, Zhang, Q H, Chen, J B, Huang, C X, Li, G S (2006). Comparison of rate control and rhythm control in patients with atrial fibrillation after percutaneous mitral balloon valvotomy: a randomised controlled study. Heart 92: 1096-1101 [Abstract] [Full Text]  
• Chan, P. S., Vijan, S., Morady, F., Oral, H. (2006). Cost-Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation. J Am Coll Cardiol 47: 2513-2520 [Abstract] [Full Text]  
• Bunch, T. J., Mahapatra, S., Bruce, G. K., Johnson, S. B., Miller, D. V., Horne, B. D., Wang, X.-L., Lee, H.-C., Caplice, N. M., Packer, D. L. (2006). Impact of Transforming Growth Factor-{beta}1 on Atrioventricular Node Conduction Modification by Injected Autologous Fibroblasts in the Canine Heart. Circulation 113: 2485-2494 [Abstract] [Full Text]  
• Hemels, M. E.W., Gu, Y. L., Tuinenburg, A. E., Boonstra, P. W., Wiesfeld, A. C.P., van den Berg, M. P., Van Veldhuisen, D. J., Van Gelder, I. C. (2006). Favorable long-term outcome of maze surgery in patients with lone atrial fibrillation.. Ann. Thorac. Surg. 81: 1773-1779 [Abstract] [Full Text]  
• Elesber, A. A., Rosales, A. G., Herges, R. M., Shen, W.-K., Moon, B. S., Malouf, J. F., Ammash, N. M., Somers, V., Hodge, D. O., Gersh, B. J., Hammill, S. C., Friedman, P. A. (2006). Relapse and mortality following cardioversion of new-onset vs. recurrent atrial fibrillation and atrial flutter in the elderly. Eur Heart J 27: 854-860 [Abstract] [Full Text]  
• Rienstra, M., Van Gelder, I. C., Hagens, V. E., Veeger, N. J.G.M., Van Veldhuisen, D. J., Crijns, H. J.G.M., for the RACE Investigators, (2006). Mending the rhythm does not improve prognosis in patients with persistent atrial fibrillation: a subanalysis of the RACE study. Eur Heart J 27: 357-364 [Abstract] [Full Text]  
• Earley, M. J, Schilling, R. J (2006). Catheter and surgical ablation of atrial fibrillation. Heart 92: 266-274 [Full Text]  
• Regan, C. P., Wallace, A. A., Cresswell, H. K., Atkins, C. L., Lynch, J. J. Jr. (2006). In Vivo Cardiac Electrophysiologic Effects of a Novel Diphenylphosphine Oxide IKur Blocker, (2-Isopropyl-5-methylcyclohexyl) Diphenylphosphine Oxide, in Rat and Nonhuman Primate. J. Pharmacol. Exp. Ther. 316: 727-732 [Abstract] [Full Text]  
• Hemels, M. E.W., Wiesfeld, A. C.P., Inberg, B., Van Dessel, P. F.H.M., Nieuwland, W., Tan, E. S., Mulder, H., Van Veldhuisen, D. J., Van Gelder, I. C. (2006). Right atrial overdrive pacing for prevention of symptomatic refractory atrial fibrillation.. Europace 8: 107-112 [Abstract] [Full Text]