Atrial Fibrillation | UMCG | Previous investigator-initiated research
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Previous investigator-initiated research

RAte Control versus Electrical Cardioversion for Persistent Atrial Fibrillation (RACE) Study.

The RACE study was initiated and led by prof.dr. Van Gelder and Crijns, dr. Rienstra was not involved in the study conductance, but joined the group of Van Gelder after main paper was published, and he performed the majority of the substudies. The RACE study was a prospective, multicenter, randomized, open-label, noninferiority trial in patients who had persistent atrial fibrillation after a previous electrical cardioversion to receive either treatment aimed at rate control or rhythm control. Patients in the rate-control group received oral anticoagulant drugs and rate-slowing medication. Patients in the rhythm-control group underwent serial cardioversions and received anti- arrhythmic drugs and oral anticoagulant drugs. The study showed that rate control is not inferior to rhythm control for the prevention of death and morbidity from cardiovascular causes and may be appropriate therapy in patients with a recurrence of persistent atrial fibrillation after electrical cardioversion. This finding has led to a change in both the European and United States guidelines on the management of atrial fibrillation. After the main findings were published in the N Engl J Med 2002;347:1834-40, 19 substudies have been published since.

 

RAte Control Efficacy in Permanent Atrial Fibrillation: a Comparison between Lenient versus Strict Rate Control II (RACE II) study.

The RACE II study was initiated and led by prof.dr. Van Gelder and Crijns, dr. Rienstra was one of the national study coordinators. This was a prospective, multicenter, randomized, open-label, noninferiority trial designed to compare two rate control strategies in patients with permanent atrial fibrillation. Goal was to investigate whether a lenient rate control was not inferior to strict rate control for preventing cardiovascular morbidity and mortality in patients with permanent atrial fibrillation. The study showed that lenient rate control is as effective as strict rate control and is easier to achieve. This finding has led to a change in both the European and United States guidelines on the management of atrial fibrillation. After the main findings were published in the N Engl J Med 2010;362:1363-1373, 8 substudies have been published since.

 

CONtinuous Versus Episodic PRophylactic Treatment with Amiodarone for the Prevention of Atrial Fibrillation (CONVERT) study.

The CONVERT study was initiated and led by prof.dr. Van Gelder and Crijns, dr. Rienstra was one of the national study coordinators. This was a multicenter, randomized controlled study in patients with recurrent symptomatic persistent atrial fibrillation. Goal was to compare major events in patients randomized to receive episodic amiodarone treatment with those who received continuous amiodarone treatment while still aiming to prevent atrial fibrillation. The study showed that there was no difference in the composite of amiodarone and cardiac major adverse events between groups. However, patients receiving episodic treatment had a significantly increased rate of atrial fibrillation recurrence and a significantly higher rate of all-cause mortality and cardiovascular hospitalizations. Results were published in JAMA 2008;300(15):1784-1792.

 

Verapamil Versus Digoxin and Acute Versus Routine Serial Cardioversion Trial (VERDICT).

The VERDICT was initiated and led by prof.dr. Van Gelder and Crijns, dr. Rienstra was one of the local investigator. This was a prospective, multicenter, randomized study to investigate whether: 1) acutely repeated serial electrical cardioversions (ECVs) after a relapse of atrial fibrillation; and 2) prevention of intracellular calcium overload by verapamil, decrease intractability of atrial fibrillation. VERDICT showed that an acute serial cardioversion strategy does not improve long-term rhythm control in comparison with a routine serial cardioversion strategy. Furthermore, verapamil has no beneficial effect in a serial cardioversion strategy. Results were published in J Am Coll Cardiol 2006;48:1001–9.

 

The Features in AT500: Chances for Patients with Episodes of Atrial Tachyarrhythmia without Bradycardia Indication for Pacing (FACET) study.

The FACET study was initiated and led by prof.dr. Van Gelder, dr. Rienstra was one of the local investigators. This was a randomized cross-over pilot study, we randomized to atrial pacing lower rate 70 ppm and prevention and ATP therapies ON or to atrial pacing lower rate 34 ppm and prevention and ATP therapies OFF during 12 weeks with a 4 week washout period in between. Goal was to investigate the efficacy of preventive and antitachycardia pacing (ATP) in patients with symptomatic paroxysmal atrial fibrillation without bradyarrhythmias. The pilot study, albeit small, showed that pacing in atrial fibrillation may significantly reduce the atrial fibrillation burden. However, it did not reveal a clinically relevant effect on the patients’ quality of life and the reduction of symptoms. Results were published in Europace 2008;10, 306–313.