Susano Lara-Vaca1, Alejandro Cordero-Cabra2, Enrique Martínez-Flores3, Pedro Iturralde-Torres4. 1. Unidad Médica de Alta Especialidad T-1, Instituto Mexicano del Seguro Social, León, Gto. 2. Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jal. 3. Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F. 4. Departamento de Electrocardiología, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Abstract
INTRODUCTION: The Mexican Registry of Atrial Fibrillation (ReMeFa) is the first national multicenter registry with one-year clinical follow-up on the treatment of atrial fibrillation (AF) in newly diagnosed patients. OBJECTIVE: To describe the demographics and treatment modalities for rhythm control (RC) strategy or heart rate (HR) control in patients with AF treated by cardiologists. A secondary objective was to prospectively evaluate the status of AF according to the chosen strategy; sinus rhythm in RC and mean ventricular rate at rest ≤ 80 bpm in HR, as well as the incidence of clinical outcomes at 12 month follow-up. METHODS: ReMeFa was a multicenter, prospective, descriptive study. We included adults with documented AF. We excluded those with AF secondary to reversible causes, undergoing pulmonary vein ablation, pacemaker or defibrillator users, with a life expectancy of less than one year, or with physical or mental impediments to meet the protocol objectives. Data were collected at baseline and at 6 and 12 months. RESULTS: We registered 1,201 subjects and 1,193 were eligible for evaluation: 40% were on RC strategy and 60% on HR control. In the RC strategy, the drugs most commonly used were class III antiarrhythmics (64%), beta-blockers (25%), and digoxin (24%). In HR control strategy, the drugs used were digoxin (69%), class III antiarrhythmics (59%), and beta-blockers (56%). Compared with those on HR control, patients in RC strategy were younger (64 ± 14 years), in sinus rhythm (55%) and with paroxysmal AF (60%) at baseline. Patients in HR control were older (68 ± 13 years), with non-paroxysmal AF (91%), valvular disease (42%), heart failure (35%), left ventricular dysfunction (33%), and diabetes (25%). At one year follow-up, a 3% incidence of ischemic stroke was observed in the HR control group, significantly higher than the 1% observed in the RC strategy (p = 0.041). CONCLUSIONS: ReMeFa registry results offer a current and comprehensive perspective on management strategies in Mexican patients with AF. The RC strategy provided better control of the arrhythmia as compared with the HR control strategy and it was associated with a lower rate of ischemic stroke. Nonetheless, current strategies of treatment of AF are not satisfactory.
INTRODUCTION: The Mexican Registry of Atrial Fibrillation (ReMeFa) is the first national multicenter registry with one-year clinical follow-up on the treatment of atrial fibrillation (AF) in newly diagnosed patients. OBJECTIVE: To describe the demographics and treatment modalities for rhythm control (RC) strategy or heart rate (HR) control in patients with AF treated by cardiologists. A secondary objective was to prospectively evaluate the status of AF according to the chosen strategy; sinus rhythm in RC and mean ventricular rate at rest ≤ 80 bpm in HR, as well as the incidence of clinical outcomes at 12 month follow-up. METHODS: ReMeFa was a multicenter, prospective, descriptive study. We included adults with documented AF. We excluded those with AF secondary to reversible causes, undergoing pulmonary vein ablation, pacemaker or defibrillator users, with a life expectancy of less than one year, or with physical or mental impediments to meet the protocol objectives. Data were collected at baseline and at 6 and 12 months. RESULTS: We registered 1,201 subjects and 1,193 were eligible for evaluation: 40% were on RC strategy and 60% on HR control. In the RC strategy, the drugs most commonly used were class III antiarrhythmics (64%), beta-blockers (25%), and digoxin (24%). In HR control strategy, the drugs used were digoxin (69%), class III antiarrhythmics (59%), and beta-blockers (56%). Compared with those on HR control, patients in RC strategy were younger (64 ± 14 years), in sinus rhythm (55%) and with paroxysmal AF (60%) at baseline. Patients in HR control were older (68 ± 13 years), with non-paroxysmal AF (91%), valvular disease (42%), heart failure (35%), left ventricular dysfunction (33%), and diabetes (25%). At one year follow-up, a 3% incidence of ischemic stroke was observed in the HR control group, significantly higher than the 1% observed in the RC strategy (p = 0.041). CONCLUSIONS: ReMeFa registry results offer a current and comprehensive perspective on management strategies in Mexican patients with AF. The RC strategy provided better control of the arrhythmia as compared with the HR control strategy and it was associated with a lower rate of ischemic stroke. Nonetheless, current strategies of treatment of AF are not satisfactory.
Authors: Humberto Rodríguez-Reyes; César I Laguna-Muñoz; Carlos F Gallegos-de Luna; Manuel O de-Los-Ríos-Ibarra; José L Salas-Pacheco; José L Leyva-Pons; Luz M Muñoz-Gutiérrez; Arturo Vargas-Hernandez; Karla M Rodríguez-Muñoz; Jaime Barragán-Luna; Marco A Alcocer-Gamba; Jorge Cortez-Lawrenz; Julio Farjat-Ruiz Journal: Arch Cardiol Mex Date: 2022-07-01