Clinical Outcomes of Rhythm Control Strategies for Asymptomatic Atrial Fibrillation According to the Quality-of-Life Score: The CODE-AF (Comparison Study of Drugs for Symptom Control and Complication Prevention of Atrial Fibrillation) Registry

Ju Youn Kim, Hyoung Seob Park, Hyung Wook Park, Eue Keun Choi, Jin Kyu Park, Jin Bae Kim, Ki Woon Kang, Jaemin Shim, Boyoung Joung, Kyoung Min Park

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Atrial fibrillation (AF) is associated with an increased risk of poor cardiovascular outcomes; appropriate rhythm control can reduce the incidence of these adverse events. Therefore, catheter ablation is recommended in symptomatic patients with AF. The aims of this study were to compare AF-related outcomes according to a baseline symptom scale score and to determine the best treatment strategy for asymptomatic patients with AF. METHODS AND RESULTS: This study enrolled all patients who completed a baseline Atrial Fibrillation Effect on Quality-of-Life (AFEQT) survey in a prospective observational registry. The patients were divided into 2 groups according to AFEQT score at baseline; scores ≤80 were defined as symptomatic, whereas scores >80 represented asymptomatic patients. The primary outcome was defined as a composite of hospitalization for heart failure, ischemic stroke, or cardiac death. This study included 1515 patients (mean age: 65.7±10.5 years; 998 [65.9%] men). The survival curve showed a poorer outcome in the symptomatic group compared with the asymptomatic group (log-rank P=0.04). Rhythm control led to a significantly lower risk of a composite outcome in asymptomatic patients (hazard ratio [HR], 0.47 [95% CI, 0.27– 0.84], P=0.01). Rhythm control was associated with more favorable composite outcomes in the asymptomatic group with paroxysmal AF, left atrium diameter ≤50 mm, and CHA2 DS2-VASc score ≥3. CONCLUSIONS: Symptomatic patients with AF experienced more adverse outcomes compared with asymptomatic patients. In asymptomatic patients with AF, a strategy of rhythm control improved the outcomes, especially with paroxysmal AF, smaller left atrium size, or higher stroke risk. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02786095.

Original languageEnglish
Article numbere025956
JournalJournal of the American Heart Association
Volume11
Issue number18
DOIs
Publication statusPublished - 2022 Sep 20

Bibliographical note

Funding Information:
This research was supported by a grant of the Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health and Welfare, Republic of Korea (Grant number: HC19C013).

Publisher Copyright:
© 2022 The Authors.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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