Clinical Outcomes of Rhythm Control Strategies for Asymptomatic Atrial Fibrillation According to the Quality-of-Life Score: The CODE-AF (Comparison Study of Drugs for Symptom Control and Complication Prevention of Atrial Fibrillation) Registryopen access
- Authors
- Kim, Ju Youn; Park, Hyoung-Seob; Park, Hyung Wook; Choi, Eue-Keun; Park, Jin-Kyu; Kim, Jin-Bae; Kang, Ki-Woon; Shim, Jaemin; Joung, Boyoung; Park, Kyoung-Min
- Issue Date
- Sep-2022
- Publisher
- WILEY
- Keywords
- atrial fibrillation; quality of life; treatment outcome
- Citation
- JOURNAL OF THE AMERICAN HEART ASSOCIATION, v.11, no.18
- Journal Title
- JOURNAL OF THE AMERICAN HEART ASSOCIATION
- Volume
- 11
- Number
- 18
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/72430
- DOI
- 10.1161/JAHA.122.025956
- ISSN
- 2047-9980
2047-9980
- Abstract
- BACKGROUND: Atrial fibrillation (AF) is associated with an increased risk of poor cardiovascular outcomes; appropriate rhythm control can reduce the incidence of these adverse events. Therefore, catheter ablation is recommended in symptomatic patients with AF. The aims of this study were to compare AF-related outcomes according to a baseline symptom scale score and to determine the best treatment strategy for asymptomatic patients with AF. METHODS AND RESULTS: This study enrolled all patients who completed a baseline Atrial Fibrillation Effect on Quality-of-Life (AFEQT) survey in a prospective observational registry. The patients were divided into 2 groups according to AFEQT score at baseline; scores <= 80 were defined as symptomatic, whereas scores >80 represented asymptomatic patients. The primary outcome was defined as a composite of hospitalization for heart failure, ischemic stroke, or cardiac death. This study included 1515 patients (mean age: 65.7 +/- 10.5 years; 998 [65.9%] men). The survival curve showed a poorer outcome in the symptomatic group compared with the asymptomatic group (log-rank P=0.04). Rhythm control led to a significantly lower risk of a composite outcome in asymptomatic patients (hazard ratio [HR], 0.47 [95% CI, 0.27-0.84], P=0.01). Rhythm control was associated with more favorable composite outcomes in the asymptomatic group with paroxysmal AF, left atrium diameter <= 50 mm, and CHA(2)DS(2)-VASc score >= 3. CONCLUSIONS: Symptomatic patients with AF experienced more adverse outcomes compared with asymptomatic patients. In asymptomatic patients with AF, a strategy of rhythm control improved the outcomes, especially with paroxysmal AF, smaller left atrium size, or higher stroke risk.
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