Impact of drug alteration to maintain rhythm control in paroxysmal Atrial fibrillation: Subanalysis From J-RHYTHM Study

Ayaka Endo, Shun Kohsaka, Shinya Suzuki, Hirotsugu Atarashi, Shiro Kamakura, Masayuki Sakurai, Haruaki Nakaya, Masahiko Fukatani, Hideo Mitamura, Tsutomu Yamazaki, Takeshi Yamashita, Satoshi Ogawa

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7 Citations (Scopus)


Background: The Japanese Rhythm Management Trial for Atrial Fibrillation (J-RHYTHM) study showed rhythm control was associated with fewer changes in the assigned treatment strategy compared to rate control in atrial fibrillation (AF). The aim was to describe how antiarrhythmics (AAs) were altered in the rhythm control arm and whether altering AAs would impact long-term outcomes. Methods and Results: Of 390 enrolled patients, 23.5% altered their AAs (drug alteration [DA] group). The hard endpoint (HE) was defined as a composite of death, stroke, embolism, major bleeding or heart failure hospitalization; soft endpoint (SE) was defined physical/psychological disability requiring alteration of treatment strategy. The patients were followed for 1.7 years. No significant difference was noted in the occurrence of HE (4.0% vs 6.5%, P=0.31), but DA-group patients had higher rates of SE (9.3% vs 18.4%, P=0.017) compared to single AA patients. The DA group was also associated with the occurrence of SE after adjustment (HR 1.90, P=0.042). When the DA group was subdivided according to the use of class III drugs or change of drugs between classes, there were no differences in outcomes. Conclusions: The need to change AA was associated with physical/psychological disabilities that seemed not to be relieved simply by changing AAs, and this should be considered as a marker for refractory paroxysmal AF requiring other strategies.

Original languageEnglish
Pages (from-to)870-875
Number of pages6
JournalCirculation Journal
Issue number5
Publication statusPublished - 2010


  • Antiarrhythmic drug
  • Atrial fibrillation
  • Outcome
  • Rhythm control

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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