Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Pharmacology (Antiarrhythmic drugs and anticoagulants) D-PO02 - Poster Session II (ID 47) Poster

D-PO02-224 - Rhythm Control Using Antiarrhythmic Drugs Did Not Improve Outcome Of Atrial Fibrillation Patients With Heart Failure: The Castle-af Trial (ID 1068)


Background: Atrial fibrillation (AF) and heart failure (HF) are always coexisting conditions, with increasing risk of hospitalization and death. The value of antiarrhythmics in this patient population is still being debated.
Objective: To determine whether rhythm control using antiarrhythmics is more effective than rate control for improving outcomes in patients with AF and HF.
Methods: We include patients that didn’t undergo AF ablation and were treated either with rate control of rhythm control using antiarrhythmic strategy. Patients were divided into Group 1 for patients taken either sotalol or amiodarone for rhythm control and Group 2 for patients taken other medicines for rate control. The primary endpoint was defined as a composite of death from any cause or worsening of heart failure that led to an unplanned hospitalization.
Results: Among 210 patients (mean age 64.1 ± 10.8 years, 83.3% male) included, 53 patients were in Group 1 and 157 patients in Group 2. At baseline, patients in group 1 were younger (61.5± 10.1 vs 65.0± 10.9 years, P=0.04). Over a median follow-up of 3.76 years, the primary end point occurred in 19 (35.8%) patients in Group 1 vs 71 (45.2%) in Group 2 (HR, 0.94; 95% CI, 0.56 to 1.56; P = 0.80) (Figure 1). No significant improvement was reported in Group 1 of all-cause mortality (8 (15.1%) vs. 42 (26.8%); HR, 0.73; 95% CI, 0.34 to 1.56; P = 0.42) and unplanned hospitalized (22 (41.5%) vs. 77 (49.0%); HR, 0.97; 95% CI, 0.60 to 1.55; P = 0.88).
Conclusion: Among AF patients with HF, rhythm control did not significantly reduce the primary composite end point of all-cause mortality or unplanned hospitalization due to cardiovascular reason when compared to rate control strategy.