Risks and Benefits of Early Rhythm Control in Patients With Acute Strokes and Atrial Fibrillation: A Multicenter, Prospective, Rancomized Study (the RAFAS Trial)
- 주제(키워드) atrial fibrillation , ischemic stroke , rhythm control , usual care
- 주제(기타) Cardiac & Cardiovascular Systems
- 설명문(일반) [Park, Junbeom; Chang, Yoonkyung; Song, Tae-Jin; Kim, Dong-Hyeok; Lee, Hye Ah] Ewha Womans Univ, Med Ctr, Seoul, South Korea; [Shim, Jaemin] Korea Univ, Med Ctr, Seoul, South Korea; [Lee, Jung Myung] Kyung Hee Univ, Med Ctr, Seoul, South Korea; [Park, Jin-Kyu] Hanyang Univ, Seoul, South Korea; [Heo, JoonNyung; Kim, Young Dae; Nam, Hyo Suk; Heo, Ji Hoe] Yonsei Univ, Dept Neurol, Coll Med, Seoul, South Korea; [Yu, Hee Tae; Kim, Tae-Hoon; Uhm, Jae-Sun; Joung, Boyoung; Lee, Moon-Hyoung; Pak, Hui-Nam] Yonsei Univ, Coll Med, Yonsei Univ Hlth Syst, Seoul, South Korea
- 등재 SCIE, SCOPUS
- OA유형 Green Published, gold
- 발행기관 WILEY
- 발행년도 2022
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000190861
- 본문언어 영어
- Published As https://doi.org/10.1161/JAHA.121.023391
- PubMed https://pubmed.ncbi.nlm.nih.gov/35043663
초록/요약
BACKGROUND: The purpose of the RAFAS (Risk and Benefits of Urgent Rhythm Control of Atrial Fibrillation in Patients With Acute Stroke) trial was to explore the risks and benefits of early rhythm control in patients with newly documented atrial fibrillation (AF) during an acute ischemic stroke (IS). METHOD AND RESULTS: An open-label, randomized, multicenter trial design was used. If AF was diagnosed, the patients in the early rhythm control group started rhythm control within 2 months after the occurrence of an IS, unlikely the usual care. The primary end points were recurrent IS within 3 and 12 months. The secondary end points were a composite of all deaths, unplanned hospitalizations from any cause, and adverse arrhythmia events. Patients (n=300) with AF and an acute IS (63.0% men, aged 69.6 +/- 8.5 years; 51.2% with paroxysmal AF) were randomized 2:1 to early rhythm control (n=194) or usual care (n=106). A total of 273 patients excluding those lost to follow-up (n=27) were analyzed. The IS recurrences did not differ between the groups within 3 months of the index stroke (2 [1.1%] versus 4 [4.2%]; hazard ratio [HR], 0.257 [log-rank P=0.091]) but were significantly lower in the early rhythm control group at 12 months (3 [1.7%] versus 6 [6.3%]; HR, 0.251 [log-rank P=0.034]). Although the rates of overall mortality, any cause of hospitalizations (25 [14.0%] versus 16 [16.8%]; HR, 0.808 [log-rank P=0.504]), and arrhythmia-related adverse events (5 [2.8%] versus 1 [1.1%]; HR, 2.565 [log-rank P=0.372]) did not differ, the proportion of sustained AF was lower in the early rhythm control group than the usual care group (60 [34.1%] versus 59 [62.8%], P<0.001) in 12 months. CONCLUSIONS: The early rhythm control strategy of an acute IS decreased the sustained AF and recurrent IS within 12 months without an increase in the composite adverse outcomes.
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