Risk factor driven upstream AF therapy improves sinus rhythm (RACE 3)

August 27, 2017

Barcelona, Spain - 27 Aug 2017: Risk factor driven upstream rhythm control is effective, feasible and safe in improving maintenance of sinus rhythm in patients with early short lasting atrial fibrillation (AF) and heart failure, according to late-breaking results from the RACE 3 trial presented today in a Hot Line - LBCT Session at ESC Congress.1 The novel therapy included meticulous treatment of risk factors and change of lifestyle and was superior to conventional guideline recommended rhythm control.

"Atrial fibrillation is the most common sustained cardiac arrhythmia and affects millions of people in Europe," said principal investigator Dr Michiel Rienstra, cardiologist and clinical director of cardiology at the University Medical Centre Groningen, the Netherlands. "Patients suffer from palpitations, shortness of breath, impaired exercise tolerance, have poor quality of life and are at increased risk of stroke, heart failure or death."

In most patients, AF is in part caused by comorbidities such as hypertension, heart failure, and obesity. AF is a progressive disease and despite the available medical and interventional therapies, long-term maintenance of normal (sinus) rhythm is cumbersome. AF and its progression are caused by structural remodelling of the left atrium. Upstream rhythm control therapy may modify atrial remodelling and help prevent AF and its progression.

The RACE 3 trial2 was designed to test the hypothesis that risk factor driven upstream therapy is superior to conventional therapy for maintenance of sinus rhythm at 12 months in patients with early persistent AF and heart failure.

This international, investigator-initiated, multicentre, prospective, open label trial included 250 patients with symptomatic early persistent AF and early mild to moderate heart failure who were scheduled for electrical cardioversion. All patients received causal treatment of AF and heart failure and were then randomly allocated to conventional guideline recommended rhythm control with or without an additional four risk factor driven upstream therapies.

The upstream therapy group received: 1) cardiac rehabilitation including physical activity, dietary restrictions, and regular counselling on drug adherence, exercise maintenance and dietary restrictions; 2) mineralocorticoid receptor antagonists; 3) statins; and 4) angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers.

Upstream therapies started at least three weeks before electrical cardioversion and were continued for 12 months. Every effort was made to optimally titrate all drugs. If AF relapsed, repeat cardioversions, antiarrhythmic drugs and atrial ablation were allowed.

The primary endpoint was the presence of sinus rhythm after one year of follow-up, assessed with continuous seven day Holter monitoring during the last week of the study. Secondary endpoints included atrial size, left ventricular function, exercise capacity, hospitalisations for heart failure and other reasons, mortality, quality of life, and side effects of upstream therapies.

At one year follow-up, sinus rhythm was present in 89 of 119 (75%) patients in the upstream therapy group compared to 79 of 126 (63%) patients in the control group (p=0.021). There was no difference in antiarrhythmic drug use or the number of electrical cardioversions between the two groups.

Dr Rienstra said: "Upstream rhythm control, including meticulous treatment of risk factors and change of lifestyle, is effective, feasible and safe in improving maintenance of sinus rhythm in patients with early short lasting AF and early mild to moderate heart failure. The upstream therapies also improved treatment of cardiovascular risk factors."

European Society of Cardiology

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.