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Atrial fibrillation management strategies and early mortality after myocardial infarction: results from the Valsartan in Acute Myocardial Infarction (VALIANT) Trial.

AbstractOBJECTIVE:
The management of patients with atrial fibrillation (AF) following a myocardial infarction (MI) remains uncertain. This study compared a rate control strategy to an anti-arrhythmic-based rhythm control strategy for the treatment of AF following myocardial infarction.
DESIGN, SETTING AND PATIENTS:
We studied 1131 patients with AF after MI who were enrolled in the Valsartan in Acute Myocardial Infarction Trial (VALIANT). We classified patients into those treated with a rhythm control strategy (n=371) and those treated with a rate control strategy (n=760).
MAIN OUTCOMES MEASURES:
Using Cox models, we compared the two groups with respect to both death and stroke during two different time periods after randomisation for which data collection had been pre-specified: 0-45 days and 45-1096 days.
RESULTS:
After adjustment, a rhythm control strategy was found to be associated with increased early mortality (0-45 days: HR: 1.9, 95% CI 1.2 to 3.0, p=0.004) but not late mortality (45-1096 days: HR 1.1, 95% CI 0.9 to 1.4, p=0.45). No difference was observed in the incidence of stroke (0-45 days: HR 1.2, 95% CI 0.4 to 3.7, p=0.73; 45-1096 days: HR 0.6, 95% CI 0.3 to 1.3, p=0.21).
CONCLUSIONS:
In patients with AF after an MI, an anti-arrhythmic drug-based rhythm control strategy is associated with excess 45-day mortality compared with a rate control strategy, but is not associated with increased mortality outside of the immediate peri-infarct period. These results potentially identify a patient population in whom the use of anti-arrhythmic drug therapy may portend an increased risk of death.
AuthorsKent R Nilsson Jr, Sana M Al-Khatib, Yi Zhou, Karen Pieper, Harvey D White, Aldo P Maggioni, Lars Kober, Christopher B Granger, Eldrin F Lewis, John J V McMurray, Robert M Califf, Eric J Velazquez
JournalHeart (British Cardiac Society) (Heart) Vol. 96 Issue 11 Pg. 838-42 (Jun 2010) ISSN: 1468-201X [Electronic] England
PMID20406769 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Anti-Arrhythmia Agents
Topics
  • Aged
  • Anti-Arrhythmia Agents (administration & dosage)
  • Atrial Fibrillation (complications, drug therapy, mortality)
  • Epidemiologic Methods
  • Female
  • Heart Failure (complications, mortality)
  • Humans
  • Male
  • Myocardial Infarction (complications, mortality)
  • Stroke (etiology, mortality)
  • Ventricular Dysfunction, Left (complications, mortality)

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