p.67 抽出テキスト

CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2024;149:e1–e156. DOI: 10.1161/CIR.0000000000001193 January 2, 2024 e67

Joglar et al 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation

data and another from a large national database, when compared with rate control, early initiation of rhythm control (<1 year) in patients with AF was associated with 15% and 19% reductions in the combined endpoint of cardiovascular death, ischemic stroke, or hospitalization for ischemia or HF, respectively.13,14 However, these recent findings must be balanced against studies that have reported increased emergency department visits and health care resource utilization associated with rhythm control.52–54

4 In the AF-CHF (Atrial Fibrillation and Congestive

Heart Failure) trial, rhythm control did not affect cardiovascular mortality but was associated with improved QOL.15,55 Contemporary trials in patients with AF and HF, regardless of LV function, and often using catheter ablation as an important therapy, have reported trends or statistically significant improvement in clinical outcomes associated with rhythm control when compared to rate control.16,17,49,56–58 In an analysis of patients with HF in EAST-AFNET 4, rhythm control was associated with a significant reduction in the composite primary endpoint of cardiovascular death, stroke, or hospitalization due to HF or acute ischemic syndrome (HR, 0.74 [95% CI, 0.56-0.97]; P=0.03).16 Similarly, in the CABANA (Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial, catheter ablation-based rhythm control was associated with a 46% reduction in the mortality rate in patients with HF compared with medical therapy.19 Although catheter ablation is more effective in maintaining sinus rhythm than antiarrhythmic drugs, maintenance of sinus rhythm was higher in the AF-CHF trial. In this study, amiodarone was the preferential strategy for rhythm control (82% of patients) compared

Figure 19. Patient and Clinical Considerations for Choosing Between Rhythm Control and Rate Control. Patient and clinical considerations for deciding between rhythm- and rate-control strategies in a patient with a high burden of AF. AF indicates atrial fibrillation; AV, atrioventricular; LA, left atrium; and LV, left ventricular.

Downloaded from http://ahajournals.org by on October 7, 2026