RecordAF presents results of recently diagnosed and treated patients with atrial fibrillation

Results from the RecordAF registry (REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation), presented today at the Scientific Sessions of the American Heart Association, show that in recently diagnosed and actively treated patients with atrial fibrillation (AF), a rhythm-control strategy provides better short term control of the arrhythmia versus a rate-control strategy but does not translate into a reduction in the occurrence of clinical events at 1 year. RecordAF also confirmed that these patients suffer from a high rate of clinical events, mainly cardiovascular (CV) hospitalisations.

RecordAF is the first international prospective, observational survey established to help assess the global burden of atrial fibrillation by investigating the way in which it is managed in "real world" clinical cardiology settings, identifying best clinical practice, and shaping the future management of the disease. 5,604 patients with recently diagnosed atrial fibrillation (first diagnosed, paroxysmal or persistent) participated in the RecordAF registry over 12 months, from Apr 2007 to Apr 2008.

"RecordAF shows that while a rhythm-control strategy achieves superior therapeutic success in atrial fibrillation than a rate-control strategy, there is no difference in the occurrence of clinical outcomes between strategies," said Prof John Camm, St George's University, London, UK, joint-lead investigator. "To truly optimise the management of atrial fibrillation we need anti-arrhythmic drugs that improve both rhythm- and rate-control and significantly reduce clinical events."

Atrial fibrillation is a potentially life-threatening disease caused by an erratic electrical activity in the heart which worsens the prognosis of patients with CV risk factors and increases the risk of hospitalization, stroke, and mortality.

RecordAF shows that a rhythm control strategy was the preferred therapeutic option (55 percent) at the start of the study. Therapeutic success (unchanged strategy; no adverse events; maintenance of sinus rhythm or reduction of heart rate less than or equal to 80 beats per minute) was 60 percent with a rhythm-control strategy compared to 47 percent with a rate-control strategy. After one year, 54 percent of patients on rate-control strategy had developed permanent atrial fibrillation compared with 13 percent of patients in the rhythm-control strategy group.

In RecordAF, a high number of patients (18%) suffered a clinical event of which 90% were CV hospitalizations. This highlights the increased CV morbidity and mortality in the AF patient population. There was no difference in the reduction of clinical events between patients on the rhythm or rate control groups with 17% vs 18% of CV events respectively.

"A large scale registry such as RecordAF improves our understanding of the impact of different therapeutic strategies on clinical outcomes," said Prof Peter Kowey, Lankenau Hospital, Wynnewood, PA, USA, joint-lead investigator. "We now know that rate-control is not an easier or better treatment strategy than rhythm-control and there is a strong argument to persist with a rhythm-control strategy."

"The incidence of atrial fibrillation is increasing rapidly and becoming a greater burden on our practices. Research such as the RecordAF registry provides a unique insight into factors that influence therapeutic success. This is very important data for physicians who manage patients with atrial fibrillation," said Prof. Eric Prystowsky, St Vincent Hospital and Health Center Program, Indianapolis, IN, USA, joint-lead investigator.