Impact of cardioversion strategy on functional capacity in patients with atrial fibrillation: The Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) Study - 21/08/11
for the ACUTE Investigators1
Reprint requests: Allan L. Klein, MD, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Desk F-15, 9500 Euclid Ave, Cleveland, OH 44195.This study was supported in part by grant-in-aid awards from the American Medical Association Education and Research Foundation (Chicago, Ill), the American Society of Echocardiography (Raleigh, NC), and Philips Medical Systems (Andover, Mass).
Résumé |
Background |
The ACUTE Trial studied a transesophageal echocardiography (TEE)–guided strategy compared with a conventional strategy for management of patients with atrial fibrillation undergoing direct current cardioversion. The primary aim was to determine if patient functional capacity, measured by the Duke Activity Status Index (DASI), would differ between treatment strategies.
Methods |
The DASI was self-administered at study enrollment and at 8-week follow-up in 1074 (88%) of 1222 total patients. Clinical outcomes associated with enrollment DASI scores and change in follow-up DASI scores were reviewed.
Results |
There was no difference between the TEE-guided (n = 544) and conventional treatment (n = 530) groups for mean baseline and 8-week DASI scores, adjusting for baseline; however, patients who improved their DASI score were more likely to be in the TEE-guided group (P = .03). Pooled group data showed that the higher the enrollment DASI score, the more it tended to be positively related to maintenance of sinus rhythm (P = .06) at 8 weeks. The lower the enrollment DASI score, the more it was predictive of death (P = .03) and bleeding (P = .01) within 8 weeks. Patients with congestive heart failure (CHF) at enrollment showed greater improvement in DASI scores at 8 weeks compared with patients without CHF (DASI Δ 45.9% vs 31.6%, P < .001).
Conclusions |
There was no difference in DASI scores between treatment groups. However, TEE-guided treatment was a predictor of improved DASI at follow-up, and subgroup analysis showed that patients with CHF did show improvement in functional capacity with cardioversion.
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Vol 149 - N° 2
P. 309-315 - février 2005 Retour au numéro
Article précédent
- Clinical factors associated with abandonment of a rate-control or a rhythm-control strategy for the management of atrial fibrillation in the AFFIRM study
- Anne B. Curtis, A. Allen Seals, Robert E. Safford, William Slater, Nicholas G. Tullo, Humberto Vidaillet, David J. Wilber, April Slee, the AFFIRM Investigators 1
- Comparative efficacy of monophasic and biphasic waveforms for transthoracic cardioversion of atrial fibrillation and atrial flutter
- Osnat T. Gurevitz, Naser M. Ammash, Joseph F. Malouf, Krishnaswamy Chandrasekaran, Ana Gabriela Rosales, Karla V. Ballman, Stephen C. Hammill, Roger D. White, Bernard J. Gersh, Paul A. Friedman
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