Clinical InvestigationElectrophysiologyClinical predictors of atrial fibrillation recurrence in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico–Atrial Fibrillation (GISSI-AF) trial
Section snippets
Methods
The rationale, design, and results of GISSI-AF trial have already been published24, 25 (Clinical Trials.gov identifier: NCT00376272). It was a prospective, multicenter, randomized, double blind, placebo-controlled trial to assess whether addition of the angiotensin II-receptor blocker (ARB) valsartan to established therapies could reduce recurrence of AF in patients with a history of AF associated with cardiovascular diseases. The ethics committee at all participating centers approved the
Results
The baseline characteristics of study population at the time of enrolment according to first recurrence of AF within 1 year of follow-up are presented in Table I.
Discussion
GISSI-AF was a pragmatic trial with broad selection criteria to mimic real clinical practice as much as possible. This post hoc analysis suggests that, in GISSI-AF patients, a history of arrhythmia and low sinus rate at enrolment were predictors of AF recurrences within a 1-year follow-up. No other clinical, demographic, or electrocardiographic parameters were associated with AF recurrences, thus precluding the possibility of devising an arrhythmic risk score for use in the clinical setting. We
Conclusions
The GISSI-AF data indicate that it is impossible to devise an arrhythmic risk score in this patient population on the basis of clinical, demographic, and electrocardiographic parameters. Only AF history and, in particular, the presence of at least 2 episodes of AF in the last 6 months had significant prognostic value independent of the modality of SR restoration.
We confirmed the antiarrhythmic effects of amiodarone in hypertensive patients. We also report for the first time the negative
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Cited by (24)
Role of left atrial speckle tracking echocardiography in predicting persistent atrial fibrillation electrical cardioversion success and sinus rhythm maintenance at 6 months
2014, Advances in Medical SciencesCitation Excerpt :A higher value of 89% was recently observed by Boriani et al. [26], however, the study included a significant proportion of patients with AF. In our research, the time from arrhythmia onset to EC was longer and amiodarone was less frequently used (28% vs. 40%) [28,29]. These factors could be responsible for the lower EC success in our patients.
Incidence of atrial fibrillation in a population with impaired glucose tolerance: The contribution of glucose metabolism and other risk factors. A post hoc analysis of the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research trial
2013, American Heart JournalCitation Excerpt :In fact, spline functions show a remarkable bifasic relationship between diastolic BP or heart rate and incident AF. A negative relationship between heart rate and incident AF has been reported in the 1,442 patients of GISSI-AF: an increase in heart rate by 1 beat/min appeared to be weakly protective toward new occurrence of a single episode (HR 0.99, 95% CI 0.99-1.00, P = .047) or multiple espisodes of AF (HR 0.98, 95% CI 0.97-0.99, P = .013) over 1 year.21 A higher rate of baseline prescription of β-blockers in patients with incident AF (48.6% vs 38.0%, P < .001) (online Appendix Supplementary Table) may partly explain the findings in NAVIGATOR.
Atrial fibrillation in the 21st century: A current understanding of risk factors and primary prevention strategies
2013, Mayo Clinic ProceedingsCitation Excerpt :The role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ARBs) in the prevention of AF is currently controversial, with some studies suggesting benefits160 and some disputing this.161 Post hoc analyses of 2 large HTN trials (the Losartan Intervention For End Point Reduction in Hypertension trial162 and the Valsartan Antihypertensive Long-term Use Evaluation trial163) demonstrated a preventive effect of ARBs on new-onset AF, whereas outcomes from other large trials (the Angiotensin II-Antagonist in Paroxysmal Atrial Fibrillation trial164 and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation trial165) have shown no benefit in the prevention of recurrent AF. Thus, although the use of ARBs in the prevention of primary AF is controversial, ARBs are likely not beneficial in the prevention of recurrent AF.
Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation
2011, American Journal of CardiologyCitation Excerpt :For example, in the Gruppo Italiano per lo Studio della Sopravvivenza Nell'Infarto Miocardico—Atrial Fibrillation trial,30 which included 1,442 patients with ≥2 documented AF episodes in the previous 6 months, there was no observed significant difference at baseline in prevalence of DM between the group in which AF recurred and the group in which AF did not recur (13.9% vs 15.4%, p = 0.44).
A Prognostic Score To Predict Atrial fibrillation Recurrence After External Electrical Cardioversion - SLAC Score
2022, Critical Pathways in Cardiology
RCT# NCT00376272.
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A complete list of GISSI-AF study committees, collaborators, and participating centers is published in the New England Journal of Medicine 2009;360:1606-1617.