Abstract: . . .  the treatment of atrial fibrillation . Semin Thorac Cardiovasc Surg 2000; 12: 15-19. 11. Atrial fibril ation follow-up investigation of rhythm management the AFFIRM study design. The Planning and Steering Committees of the AFFIRM Study for the NHLBI AFFIRM Investigators. Am J Cardiol 1997; 79: 1198-1202. ? Summary of the findings of two major studies examining rate control and rhythm control in atrial fibrillation AFFIRM 3 Dutch study 4 Number of participants 4060 522 Mean duration of follow-up 3.5 years 2.3 years Mean age at baseline 70 years 68 years Females 39% 36% Event Rate Rhythm Difference significant? ( P ) Rate Rhythm Difference significant? Primary . . .
. . .  (0.001) Prolongation of corrected QT interval (> 520 ms) 0.3% 1.9% Yes (< 0.001) Other adverse events 14.0% 25.4% Yes (< 0.001) * All-cause mortality for the AFFIRM trial, 3 and a composite primary endpoint which included heart failure, thromboembolism, bleeding, need for pacemaker implantation, death from cardiovascular causes, and other severe adverse effects of drugs for the Dutch trial. 4 Prompting discontinuation of a drug.  . . .
. . .  39% (Dutch), respectively, of patients being treated for rhythm control at the conclusion of the trials. The proportion of patients taking warfarin remained above 70% in the AFFIRM study, and above 86% in the Dutch trial. Most disappointingly, the strategy failed to reduce the rates of stroke, other thromboembolic complica- tions, or haemorrhages compared with rate control (see Box). Of the 80 ischaemic strokes incurred in the AFFIRM trials rhythm-control arm, 55% occurred after discontinuation of warfarin. A further 21% occurred during warfarin treatment, while patients international normalised ratios (INR) were <2.0. Only 31% had AF at the time of their stroke. These findings suggest that it may be unsafe to stop anticoagulation for AF patients treated with a rhythm-control strategy, unless there are . . .
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