Routine versus aggressive upstream rhythm control for prevention of early atrial fibrillation in heart failure: background, aims and design of the RACE 3 study

详细信息    查看全文

• 作者：M. Alings (1)
  M. D. Smit (2)
  M. L. Moes (2)
  H. J. G. M. Crijns (3)
  J. G. P. Tijssen (4)
  J. Brügemann (2) (5)
  H. L. Hillege (2) (6)
  D. A. Lane (7)
  G. Y. H. Lip (7)
  J. R. L. M. Smeets (8)
  R. G. Tieleman (9)
  R. Tukkie (10)
  F. F. Willems (11)
  R. A. Vermond (2)
  D. J. Van Veldhuisen (2)
  I. C. Van Gelder (2)
  
• 关键词：Atrial fibrillation ; Secondary prevention ; Upstream therapy ; Heart failure
• 刊名：Netherlands Heart Journal
• 出版年：2013
• 出版时间：July 2013
• 年：2013
• 卷：21
• 期：7-8
• 页码：354-363
• 全文大小：
• 作者单位：M. Alings (1)
  M. D. Smit (2)
  M. L. Moes (2)
  H. J. G. M. Crijns (3)
  J. G. P. Tijssen (4)
  J. Brügemann (2) (5)
  H. L. Hillege (2) (6)
  D. A. Lane (7)
  G. Y. H. Lip (7)
  J. R. L. M. Smeets (8)
  R. G. Tieleman (9)
  R. Tukkie (10)
  F. F. Willems (11)
  R. A. Vermond (2)
  D. J. Van Veldhuisen (2)
  I. C. Van Gelder (2)
  
  1. Department of Cardiology, Amphia Hospital, Breda, the Netherlands
  2. Department of Cardiology, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
  3. Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
  4. Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
  5. Cardiac Rehabilitation Center, University Medical Center Groningen, Groningen, the Netherlands
  6. Trial Coordination Center, Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
  7. University of Birmingham Center for Cardiovascular Sciences, City Hospital, Birmingham, UK
  8. Department of Cardiology, University Medical Center Nijmegen, Nijmegen, the Netherlands
  9. Department of Cardiology, Martini Hospital Groningen, Groningen, the Netherlands
  10. Department of Cardiology, Kennemer Gasthuis, Haarlem, the Netherlands
  11. Department of Cardiology, Rijnstate Hospital, Arnhem/Velp, the Netherlands
  
• ISSN：1876-6250

文摘

Background Rhythm control for atrial fibrillation (AF) is cumbersome because of its progressive nature caused by structural remodelling. Upstream therapy refers to therapeutic interventions aiming to modify the atrial substrate, leading to prevention of AF. Objective The Routine versus Aggressive upstream rhythm Control for prevention of Early AF in heart failure (RACE 3) study hypothesises that aggressive upstream rhythm control increases persistence of sinus rhythm compared with conventional rhythm control in patients with early AF and mild-to-moderate early systolic or diastolic heart failure undergoing electrical cardioversion. Design RACE 3 is a prospective, randomised, open, multinational, multicenter trial. Upstream rhythm control consists of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers, mineralocorticoid receptor antagonists, statins, cardiac rehabilitation therapy, and intensive counselling on dietary restrictions, exercise maintenance, and drug adherence. Conventional rhythm control consists of routine rhythm control therapy without cardiac rehabilitation therapy and intensive counselling. In both arms, every effort is made to keep patients in the rhythm control strategy, and ion channel antiarrhythmic drugs or pulmonary vein ablation may be instituted if AF relapses. Total inclusion will be 250 patients. If upstream therapy proves to be effective in improving maintenance of sinus rhythm, it could become a new approach to rhythm control supporting conventional pharmacological and non-pharmacological rhythm control.