Aggressive approach and outcome in patients presenting atrial fibrillation and hypertension

AimAggressive approach in patients presenting atrial fibrillation (AF) and hypertension could result in improving rhythm control and reducing admission.MethodsOut of 3475 patients presenting AF, those with hypertension (n = 1739, 52%) underwent standard (n = 591, group 1, years 2004-2005) or aggressive pharmacological and electrical approach (n = 1148, group 2, years 2006-2009). Overall, in 1071 patients AF duration was less than 48 h. Primary endpoint was rhythm conversion; secondary endpoints were modalities of rhythm conversion and reduction of admissions.ResultsAt univariate and multivariate analyses, AF lasting less than 48 h, absence of comorbidities and younger age were independent predictors of sinus rhythm; conversely, lack of sinus rhythm, older age, AF lasting more than 48 h and comorbidities were independent predictors of hospitalization. Overall, 55% of patients achieved sinus rhythm in group 1 versus 62% in group 2 (p = 0.018). Interestingly, in patients with AF lasting less than 48 h, 89% achieved sinus rhythm, more likely by class 1C than by class III antiarrhythmic drugs (p < 0.001). Overall reduction of admission accounts for 60%; 50% of patients need admission in group 1 versus 29% in group 2 (p < 0.001).ConclusionsAggressive pharmacological and electrical approach in patients presenting AF and hypertension significantly improved rhythm conversion overall up to 62%. Patients with AF lasting less than 48 h eventually achieved sinus rhythm up to 89%, mostly by class IC antiarrhythmic drugs. Admissions eventually reduced up to 60%.

Condensed abstractPatients presenting atrial fibrillation (AF) and hypertension underwent standard (n = 591, group 1) or aggressive pharmacological and electrical approach (n = 1148, group 2). Endpoints were rhythm conversion, modalities of rhythm conversion and admissions. Recent onset AF, no comorbidities and younger age were predictors of sinus rhythm; lack of sinus rhythm, older age, long lasting AF and comorbidities were predictors of hospitalization. In group 2, 62% of patients achieved sinus rhythm (p = 0.018 versus group 1) and reduction of admission accounts for 60% (p < 0.001 versus group 1). In 1071 patients with recent onset AF, 89% achieved sinus rhythm, more likely by class 1C antiarrhythmic drugs.