Ctaf trial

Angiotensin-converting enzyme inhibitors are a standard-of-care treatment option for patients with hypertension; however, there is conflicting evidence about their effects on AF recurrence. Therefore, our objective was to assess the efficacy of perindopril, compared with placebo, to reduce AF recurrence in patients with hypertension and AF. Methods: In a multicenter, double-blind, placebo-controlled trial, patients with hypertension and symptomatic AF were randomly assigned to perindopril or placebo based on a stratification factor of antiarrhythmic drug use.

Patients who are diagnosed with permanent AF are at higher risk of adverse outcomes, and some treatment strategies are not appropriate. Data from Gillis et al 1 and Sanoski and Bauman.

Application to Mr G. He is likely experiencing persistent AF. There are several potential underlying causes of AF that must be investigated before treatment is initiated with a rate- or rhythm-control strategy. Table 2 1 , 3 , 4 illustrates the most common risk factors for the development of AF from both cardiovascular and noncardiovascular causes. Caution Mr G. Data from Gillis et al. When a patient possesses factors that favour both rate control and rhythm control, patient preference, quality of life, comorbidities, side effects, and drug interactions with concomitant medications might also help to guide choice of therapy.

Overall, the above patient factors favour rate control. The benefits of rate control are explained to Mr G. Algorithms for AF treatment strategies based on patient-specific factors such as comorbid conditions are provided in Figure 1 4 rate control and Figure 2 4 rhythm control.

Table 5 1 , 4 , 17 - 19 provides an overview of usual dosing, advantages, disadvantages, and cost for selected drug therapies. The discussion below will highlight important treatment considerations. Effective for rate control at rest and with exercise, but no remarkable effects on exercise capacity. Less effective for controlling HR during exercise, but might lead to increased exercise capacity.

CTAF trial 18 showed amiodarone was more efficacious at preventing AF than propafenone or sotalol were. Safety: many serious side effects that require judicious monitoring see Table 7. Considerable drug interactions especially with warfarin; must decrease warfarin dose.

Not covered by provincial formularies not recommended by CDR Can be used for the pill-in-the-pocket strategy in patients without structural heart disease. Pill-in-the-pocket strategy: first dose is usually given and observed by a cardiologist.

Data from Gillis et al 1 and Jin and Kosar 4. A fast-acting atrioventricular nodal blocking agent such as metoprolol should be used in conjunction to prevent concealed conduction that can progress to ventricular tachycardia or fibrillation. First-time administration requires observation and is usually performed by a cardiologist. Pill-in-the-pocket dosing for flecainide and propafenone can be found in Table 5.

Dronedarone has received increased attention as a novel agent for the treatment of arrhythmias in the hope of finding a safer alternative to amiodarone therapy. Use might be considered in patients with paroxysmal or persistent AF for rhythm control if no contraindications are present, or as add-on therapy for inadequate rate control. Consider referral to a cardiologist for radiofrequency catheter ablation RFCA as a treatment option in symptomatic patients who are refractory or intolerant to antiarrhythmics.

Only nondihydropyridine calcium channel blockers verapamil and diltiazem are indicated owing to their atrioventricular node blocking actions. Other calcium channel blockers amlodipine, nifedipine, and felodipine are not appropriate, as this is not their main mechanism of action.

Digoxin is not appropriate for Mr G. Generally, more lenient rate control is easier to achieve with fewer medications, lower doses less risk for side effects , and fewer physician visits.

The guidelines adopted a target of below BPM because the mean heart rate over 3 years in the less stringent group was approximately BPM. A detailed trial summary is available from CFPlus. All patients should be followed regularly to assess the efficacy and safety of their current therapy, regardless of whether a rate- or rhythm-control approach is taken, or of the pharmacologic agent used.

He is taking appropriate anticoagulation therapy warfarin. His diltiazem is discontinued and replaced with metoprolol to manage both his HF and rate control. However, after a few days of mg of sustained-release metoprolol daily, he remains symptomatic with AF episodes. After baseline thyroid function tests, liver function tests, and chest x-ray examination, the cardiologist decides to load the patient with amiodarone.

Upon discharge, Mr G. The primary end point is the time to the first relapse of AF. Data will be analyzed on an intention-to-treat basis. Secondary outcomes are medication toxicity, mortality, major clinical events, costs of each approach, and quality of life. The use of the common traffic advisory frequency CTAF for traffic information is a great tool when it is used correctly. Sadly it too often sounds like channel 19 on the CB radio. Aviation communication, on the other hand has a greater safety mission and therefore needs to be more precise and less prone to misunderstanding.

So when the CTAF begins to sound more like the CB it not only makes us sound unprofessional but it also reduces airport safety.