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      2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.

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      Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

      Oxford University Press (OUP)

      AF surgery, Antiarrhythmic drugs, Anticoagulation, Atrial fibrillation, Cardioversion, Catheter ablation, Guidelines, Left atrial ablation, Left atrial appendage occlusion, Non-vitamin K antagonist oral anticoagulants, Pulmonary vein isolation, Rate control, Rhythm control, Upstream therapy, Valve repair, Vitamin K antagonists

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          A comparison of rate control and rhythm control in patients with atrial fibrillation.

          There are two approaches to the treatment of atrial fibrillation: one is cardioversion and treatment with antiarrhythmic drugs to maintain sinus rhythm, and the other is the use of rate-controlling drugs, allowing atrial fibrillation to persist. In both approaches, the use of anticoagulant drugs is recommended. We conducted a randomized, multicenter comparison of these two treatment strategies in patients with atrial fibrillation and a high risk of stroke or death. The primary end point was overall mortality. A total of 4060 patients (mean [+/-SD] age, 69.7+/-9.0 years) were enrolled in the study; 70.8 percent had a history of hypertension, and 38.2 percent had coronary artery disease. Of the 3311 patients with echocardiograms, the left atrium was enlarged in 64.7 percent and left ventricular function was depressed in 26.0 percent. There were 356 deaths among the patients assigned to rhythm-control therapy and 310 deaths among those assigned to rate-control therapy (mortality at five years, 23.8 percent and 21.3 percent, respectively; hazard ratio, 1.15 [95 percent confidence interval, 0.99 to 1.34]; P=0.08). More patients in the rhythm-control group than in the rate-control group were hospitalized, and there were more adverse drug effects in the rhythm-control group as well. In both groups, the majority of strokes occurred after warfarin had been stopped or when the international normalized ratio was subtherapeutic. Management of atrial fibrillation with the rhythm-control strategy offers no survival advantage over the rate-control strategy, and there are potential advantages, such as a lower risk of adverse drug effects, with the rate-control strategy. Anticoagulation should be continued in this group of high-risk patients. Copyright 2002 Massachusetts Medical Society
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            Self-management education: History, definition, outcomes, and mechanisms

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              ESC Guidelines for the management of grown-up congenital heart disease (new version 2010).

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                Author and article information

                Journal
                Europace
                Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
                Oxford University Press (OUP)
                1532-2092
                1099-5129
                Nov 2016
                : 18
                : 11
                Affiliations
                [1 ] The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines.
                Article
                euw295
                10.1093/europace/euw295
                27567465

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