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Comparative evaluation of rhythm control versus rate control strategy in patients with persistent atrial fibrillation


Author: Cenuşă Octavian
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Rheumatology
Year:2009
Scientific adviser: Aurel Grosu
doctor habilitat, professor, Public Medico-Sanitary Institution Moldavian Institute of Cardiology
Institution:
Scientific council:

Status

The thesis was presented on the 5 March, 2009
Approved by NCAA on the 23 April, 2009

Abstract

Adobe PDF document0.33 Mb / in romanian

Thesis

CZU 616.12-008.313-08

Adobe PDF document 0.90 Mb / in romanian
100 pages


Keywords

atrial fibrillation, rhythm control, rate control, symptoms score, exercise tolerance, treatment compliance

Summary

The study included 168 patients with persistent atrial fibrillation: 20 of them accepted permanent atrial fibrillation from the begining, in 148 patients pharmacological or electrical cardioversion with the restoring of sinus rhythm was performed. The follow-up period was 365±14 days. During the follow-up, 62 patients maintained sinus rhythm till the end of the study, and 56 patients needed repeated cardioversions, the rest (30 patients), because of arrhythmia relapses, prefered rate control strategy. Rhythm control group included 118 patients, mean age 52.67±0.70 years, and rate control group contained 50 patients, mean age 55.12±0.98 years.

Rhythm control was posible in 69.6% patients, including 36.9% without arrhythmia relapses. There were no significant statistical changes in dynamic evaluation of ecocardiographic data in rhythm control group, but in rate control group dilatation of cardiac chambers, decrease of ejection fraction and increase of valvular regurgitation was observed. Patients from rhythm control group had lower symptoms score (8.21 vs 13.04, p<0.001) and a higher exercise tolerance measured with 6 minute walk test (493.52 vs 463.50 m, p<0.001) in comparison with those from rate control group. The rhythm control strategy is more expensive than the control of ventricular rate (1111.65 vs 1045.54 MDL), and the hospitalizations represented the major cost driver (31.6% and 58.4%). The compliance of patients did not affect significantly evolution of ecocardiographic data, symptoms score and exercise tolerance in both groups. In patients with atrial fibrillation a greater importance had the adequacy of rate control which ensured the absence of development or progression of tachycardia induced cardiomiopathy, lower symptoms score and higher exercise tolerance.