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Eur Heart J. 2018 Aug 21;39(32):2987-2996. doi: 10.1093/eurheartj/ehx739.

Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation: results of the RACE 3 trial.

Author information

1
Department of Cardiology, University of Groningen University Medical Centre Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
2
Department of Cardiology, Amphia Hospital, Breda, The Netherlands.
3
Julius Clinical, Zeist, The Netherlands.
4
Department of Cardiology, Academic Medical Centre - University of Amsterdam, Amsterdam, The Netherlands.
5
Department of Cardiology, Martini Hospital, Groningen, The Netherlands.
6
Department of Cardiology, Spaarne Hospital, Haarlem, The Netherlands.
7
Department of Cardiology, Maastricht University Medical Centre+, The Netherlands.
8
Cardiovascular Research Institute Maastricht, The Netherlands.

Abstract

Aims:

Atrial fibrillation (AF) is a progressive disease. Targeted therapy of underlying conditions refers to interventions aiming to modify risk factors in order to prevent AF. We hypothesised that targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent AF.

Methods and results:

We randomized patients with early persistent AF and mild-to-moderate heart failure (HF) to targeted therapy of underlying conditions or conventional therapy. Both groups received causal treatment of AF and HF, and rhythm control therapy. In the intervention group, on top of that, four therapies were started: (i) mineralocorticoid receptor antagonists (MRAs), (ii) statins, (iii) angiotensin converting enzyme inhibitors and/or receptor blockers, and (iv) cardiac rehabilitation including physical activity, dietary restrictions, and counselling. The primary endpoint was sinus rhythm at 1 year during 7 days of Holter monitoring. Of 245 patients, 119 were randomized to targeted and 126 to conventional therapy. The intervention led to a contrast in MRA (101 [85%] vs. 5 [4%] patients, P < 0.001) and statin use (111 [93%] vs. 61 [48%], P < 0.001). Angiotensin converting enzyme inhibitors/angiotensin receptor blockers were not different. Cardiac rehabilitation was completed in 109 (92%) patients. Underlying conditions were more successfully treated in the intervention group. At 1 year, sinus rhythm was present in 89 (75%) patients in the intervention vs. 79 (63%) in the conventional group (odds ratio 1.765, lower limit of 95% confidence interval 1.021, P = 0.042).

Conclusions:

RACE 3 confirms that targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent AF.

Trial Registration number:

Clinicaltrials.gov NCT00877643.

PMID:
29401239
DOI:
10.1093/eurheartj/ehx739

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