Vol 59, No 7 (2003)
Other
Published online: 2005-12-12
Submitted: 2012-12-28
Get Citation

Rhythm control versus rate control in patients with persistent atrial fibrillation. Results of the HOT CAFE Polish Study

Grzegorz Opolski, Adam Torbicki, Dariusz Kosior, Marcin Szulc, Maria Zawadzka, Magdalena Pierścińska, Piotr Kołodziej, Beata Wożakowska-Kapłon, Piotr Achremczyk, Daniel Rabczenko
Kardiol Pol 2003;59(7):8-14.
Vol 59, No 7 (2003)
Other
Published online: 2005-12-12
Submitted: 2012-12-28

Abstract

Background: Patients with atrial fibrillation (AF) can be managed either by maintaining sinus rhythm using antiarrhythmic drugs and/or electrical cardioversion, or by leaving patients in AF and controlling ventricular rate without attempts to restore sinus rhythm. Which of these two strategies is superior, has not yet been definitively established.
Aim: HOT CAFE Polish Study (How To Treat Chronic Atrial Fibrillation) was designed to evaluate in a randomised, multicentre and prospective manner the risks and advantages of two therapeutical strategies - rate control or rhythm control, in patients with persistent AF.
Methods: The study group consisted of 205 patients (71 females and 134 males; mean age 60.8±11.2 years) with a mean time of AF duration of 273.7±112.4 days; 101 patients were randomly assigned to rate control (Group I) whereas 104 patients were randomised to sinus rhythm (SR) restoration by DC cardioversion (CV) and subsequent antiarrhythmic drug treatment (Group II). At the end of follow-up (12 months) SR was present in 75% of patients.
Results: The incidence of hospital admissions was higher in group II in comparison to group I (12% vs 74%; p<0.001). Mortality was similar in both groups (1.0% versus 2.9%, NS). In both groups a significant improvement of heart failure symptoms was observed during the first 2 months (p<0.02 and p<0.001). In group II exercise tolerability measured by maximal workload during treadmill test significantly improved compared with baseline (5.2&#177;5.1 vs 7.6&#177;3.3 MET; p<0.0001). In patients in whom SR was restored, the left ventricular function improved and an increase in the shortening fraction was observed (29&#177;7% vs 31&#177;7%; p<0.01). No thromboembolic complications were observed in patients left with AF. Three patients from group II suffered ischaemic stroke; in two cases stroke was associated with CV whereas in the third patient - with late AF recurrence.
Conclusions: The HOT CAFE Polish Study did not reveal significant differences in mortality between the two treatment strategies in patients with persistent AF. Although patients with SR had better improvement in some haemodynamical parameters, the hospitalisation rate was higher and the incidence of stroke was not reduced compared with the rate control group.

Abstract

Background: Patients with atrial fibrillation (AF) can be managed either by maintaining sinus rhythm using antiarrhythmic drugs and/or electrical cardioversion, or by leaving patients in AF and controlling ventricular rate without attempts to restore sinus rhythm. Which of these two strategies is superior, has not yet been definitively established.
Aim: HOT CAFE Polish Study (How To Treat Chronic Atrial Fibrillation) was designed to evaluate in a randomised, multicentre and prospective manner the risks and advantages of two therapeutical strategies - rate control or rhythm control, in patients with persistent AF.
Methods: The study group consisted of 205 patients (71 females and 134 males; mean age 60.8&#177;11.2 years) with a mean time of AF duration of 273.7&#177;112.4 days; 101 patients were randomly assigned to rate control (Group I) whereas 104 patients were randomised to sinus rhythm (SR) restoration by DC cardioversion (CV) and subsequent antiarrhythmic drug treatment (Group II). At the end of follow-up (12 months) SR was present in 75% of patients.
Results: The incidence of hospital admissions was higher in group II in comparison to group I (12% vs 74%; p<0.001). Mortality was similar in both groups (1.0% versus 2.9%, NS). In both groups a significant improvement of heart failure symptoms was observed during the first 2 months (p<0.02 and p<0.001). In group II exercise tolerability measured by maximal workload during treadmill test significantly improved compared with baseline (5.2&#177;5.1 vs 7.6&#177;3.3 MET; p<0.0001). In patients in whom SR was restored, the left ventricular function improved and an increase in the shortening fraction was observed (29&#177;7% vs 31&#177;7%; p<0.01). No thromboembolic complications were observed in patients left with AF. Three patients from group II suffered ischaemic stroke; in two cases stroke was associated with CV whereas in the third patient - with late AF recurrence.
Conclusions: The HOT CAFE Polish Study did not reveal significant differences in mortality between the two treatment strategies in patients with persistent AF. Although patients with SR had better improvement in some haemodynamical parameters, the hospitalisation rate was higher and the incidence of stroke was not reduced compared with the rate control group.
Get Citation

Keywords

persistent atrial fibrillation - electrocardioversion - antiarrhythmic therapy - anticoagulation therapy - rhythm control - rate control

About this article
Title

Rhythm control versus rate control in patients with persistent atrial fibrillation. Results of the HOT CAFE Polish Study

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 59, No 7 (2003)

Pages

8-14

Published online

2005-12-12

Bibliographic record

Kardiol Pol 2003;59(7):8-14.

Keywords

persistent atrial fibrillation - electrocardioversion - antiarrhythmic therapy - anticoagulation therapy - rhythm control - rate control

Authors

Grzegorz Opolski
Adam Torbicki
Dariusz Kosior
Marcin Szulc
Maria Zawadzka
Magdalena Pierścińska
Piotr Kołodziej
Beata Wożakowska-Kapłon
Piotr Achremczyk
Daniel Rabczenko

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl