Real-life observations of clinical outcomes with rhythm- and rate-control therapies for atrial fibrillation RECORDAF (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation). Progression of atrial fibrillation in the REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation cohort: clinical correlates and the effect of rhythm-control therapy. Atrial fibrillation in patients with heart failure: Role of catheter ablation therapies. Improved endothelial function in patients with atrial fibrillation through maintenance of sinus rhythm by successful catheter ablation. Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation. Symptomatic and asymptomatic atrial fibrillation after pulmonary vein ablation and the impact on quality of life. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. Gender-related differences in catheter ablation of atrial fibrillation. Clinical predictors of atrial fibrillation recurrence in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation (GISSI-AF) trial. Primary Persistent Atrial Fibrillation: A Distinct Arrhythmia Subentity of an Ablation Population. Efficacy and late recurrences with wide electrical pulmonary vein isolation for persistent and permanent atrial fibrillation. Evaluation of an individualized strategy of cavotricuspid isthmus ablation as an adjunct to atrial fibrillation ablation. Lack of evidence of increased mortality among patients with atrial fibrillation taking digoxin: findings from post hoc propensity-matched analysis of the AFFIRM trial. A randomized assessment of the incremental role of ablation of complex fractionated atrial electrograms after antral pulmonary vein isolation for long-lasting persistent atrial fibrillation. Cardiac rate normalization in chronic atrial fibrillation: comparison of long-term efficacy of treatment with amiodarone versus AV node ablation and permanent His-bundle pacing.
OBJECTIVES RECORDAF is the first worldwide , prospect i ve , observational survey of management of atrial fibrillation ( AF ) in unselected , community-based patients . BACKGROUND Primary outcomes were therapeutic success and clinical outcomes associated with rhythm-control and rate-control strategies . METHODS Patients with recent-onset AF were included ( n = 5,604 ) . Treatment strategy ( rhythm control or rate control ) was noted at baseline . Follow-up was 12 months . Therapeutic success required that strategy was unchanged without clinical events . Further maintenance of sinus rhythm was required in the rhythm-control group , and heart rate ≤80 beats/min in the rate-control group . RESULTS Data from 5,171 patients were assessable . Therapeutic success was 54 % overall ( rhythm control 60 % vs. rate control 47 % ) , a result driven by control of AF : rhythm control , 81 % vs. rate control , 74 % . After adjustment for propensity score quintiles , the rhythm-control strategy was significantly related to superior therapeutic success ( odds ratio : 1.34 , 95 % confidence interval : 1.15 to 1.55 ; p = 0.0002 ) . Clinical events occurred in 18 % of patients . The arrhythmia management strategy was not predictive of clinical events . The type ( persistent ) , presence at baseline visit , and duration ( > 3 months ) of AF , together with age older than 75 years and the presence of heart failure , predicted progression to permanent AF . The choice of rhythm control reduced the likelihood of AF progression ( odds ratio : 0.20 , 95 % confidence interval : 0.17 to 0.25 ; p < 0.0001 ) . CONCLUSIONS Clinical outcomes in AF patients were driven mainly by hospitalizations for arrhythmia/proarrhythmia and other cardiovascular causes , but not by the choice of rate or rhythm strategy . Rhythm-control patients progressed less rapidly to permanent AF INTRODUCTION Paroxysmal atrial fibrillation ( AF ) may progress to persistent AF . We studied the clinical correlates and the effect of rhythm-control strategy on AF progression . METHODS RecordAF was a worldwide prospect i ve survey of AF management . Consecutive eligible patients with recent-onset AF were included and allocated to rate or rhythm control according to patient/physician choice . A total of 2,137 patients were followed up for 12 months . Atrial fibrillation progression was defined as a change from paroxysmal to persistent/permanent AF . RESULTS Progression of AF occurred in 318 patients ( 15 % ) after 1 year . Patients with AF progression  were older ; had a higher diastolic blood pressure ; and more often had a history of coronary artery disease , stroke or transient ischemic attack , hypertension , or heart failure . Patients treated with rhythm control were less likely to show progression than those treated only with rate control ( 164/1542 [ 11 % ] vs 154/595 [ 26 % ] , P < .001 ) . Multivariable analysis showed that history of heart failure ( odds ratio [ OR ] 2.2 , 95 % CI 1.7 - 2.9 , P < .0001 ) , history of hypertension ( OR 1.5 , 95 % CI 1.1 - 2.0 , P = .01 ) , and rate control rather than rhythm control ( OR 3.2 , 95 % CI 2.5 - 4.1 , P < .0001 ) were independent predictors of AF progression . The propensity score-adjusted OR of AF progression in patients with rate rather than rhythm control was 3.3 ( 95 % CI 2.4 - 4.6 , P < .0001 ) . CONCLUSIONS Although heart failure and hypertension are associated with AF progression , rhythm control is associated with lower risk of AF progression Atrial fibrillation ( AF ) represents the most common sustained cardiac arrhythmia in patients with heart failure ( HF ) . AF in HF patients is associated with worsening of symptoms and also results in a substantial increase in mortality . Although HF patients in sinus rhythm have a better outcome than patients with AF , several r and omized studies investigating pharmacological rhythm control versus rate control have shown no advantage of one strategy over the other in terms of patient outcomes . Catheter-based ablation therapy is a newer therapeutic option with a rapidly evolving and changing role in the management of this arrhythmia . In the present review , the authors discuss the epidemiology , pathophysiology and prognostic significance of AF in patients with HF . Exclusively addressed are studies investigating catheter-based ablation for rhythm-control and rate-control therapies in the management of AF in HF patients BACKGROUND Although atrial fibrillation ( AF ) is a risk factor for endothelial dysfunction ( ED ) , the effect of catheter ablation ( CA ) on AF-associated ED has not been evaluated . The aims of this study are to determine if the degree of ED predicts the outcome of AF ablation and to evaluate whether ED can be improved through restoring sinus rhythm ( SR ) by successful CA . METHODS This study prospect ively enrolled 80 subjects who underwent CA for AF ( paroxysmal AF = 61 , persistent AF = 19 ) . Eighty subjects with no history of AF were enrolled as controls , all of whom were matched by age , gender , body mass index , and atherosclerotic risk factor distribution . Brachial artery flow-mediated dilatation ( FMD ) was measured at baseline , and at 1 month and 6 months post CA in AF subjects who remained in SR . Among controls , FMD was measured at baseline and at 6 months . We used high sensitivity C-reactive protein ( hs-CRP ) , interleukin-6 , soluble E- or P-selectin , and endothelin-1 as biomarker indices for inflammation and /or ED . RESULTS Compared with controls , AF subjects had lower FMD at baseline ( FMD(baseline ) , P < 0.001 ) . After successful CA , FMD was significantly improved at 1 month and 6 months , nearly approaching control levels . A multivariate analysis revealed that FMD(baseline ) , hs-CRP , and left atrial volume ( LAV ) were independent predictors for arrhythmia recurrence after CA . Other biomarkers were not related to rhythm outcome . CONCLUSION AF subjects have significantly impaired FMD , which can be reversed through maintenance of SR by successful CA . FMD(baseline ) , hs-CRP , and LAV are important predictors for AF recurrence after CA AIMS To gain insight in the prognosis and treatment of atrial fibrillation ( AF ) patients during 1-year follow-up in the Euro Heart Survey ( EHS ) on AF . METHODS AND RESULTS The EHS enrolled 5333 AF patients in 2003 - -2004 . One-year follow-up data were available for 80 % . Of first detected AF patients , 46 % did not have a recurrence during 1 year , paroxysmal AF largely remained paroxysmal AF ( 80 % ) , and 30 % of persistent AF progressed to permanent AF . Many treatment changes occurred since baseline . Oral anticoagulation was started in 19 % and discontinued in 16 % of all patients . Of patients initially on rhythm control 27 % did not receive rhythm control during follow-up , whereas 15 % of patients initially on rate control received rhythm control . Mortality was highest in permanent AF ( 8.2 % ) , but also substantial in first detected AF ( 5.7 % ) . In multivariable analysis , sinus rhythm at baseline was associated with lower mortality , but no significant effect was observed regarding the application of either rhythm or rate control . CONCLUSION The EHS on AF provides unique prospect i ve observational data on AF progression , long-term treatment , prognosis , and determinants of adverse outcome of the total clinical spectrum of AF in a European cardiology-based patient cohort BACKGROUND The aim of this prospect i ve study was to evaluate the recurrences of atrial fibrillation ( AF ) and flutter ( AFL ) after circumferential pulmonary vein ablation ( CPVA )  using repetitive long-term Holter recordings , and to evaluate the change in quality of life ( QoL ) , especially in patients with asymptomatic AF recurrences . METHODS A total of 149 patients with AF were followed up with 7-day Holter monitoring at 3 , 6 , and 12 months after CPVA .  We calculated the burden of AF/AFL defined as the percentage of time in AF/AFL , and patients with documented arrhythmia were divided into isolated symptomatic episodes of arrhythmia , mixed symptomatic/asymptomatic arrhythmia , or isolated asymptomatic arrhythmia . The QoL was analyzed with SF-36 question naires in patients with sinus rhythm after CPVA , and in patients with recurrence of symptomatic and asymptomatic arrhythmia , respectively . RESULTS Asymptomatic arrhythmia was observed in 44 % of the patients with documented arrhythmia at 12 months of follow-up . In patients with persistent AF , 63 % of the documented arrhythmia at 12 months of follow-up was asymptomatic and often persistent . In the subgroup of patients with asymptomatic arrhythmia , the QoL improved significantly in the physical scores , in contrast to patients with symptomatic arrhythmia who had unchanged or worsened QoL scores . CONCLUSIONS Asymptomatic arrhythmia is very common after AF ablation . Our data indicate that these patients improve their physical component of the QoL significantly , which may be considered a palliative success of treatment . We suggest that patients with asymptomatic AF recurrences are carefully evaluated before considering reablation . Repetitive rhythm monitoring after AF ablation is very important considering the postablation management of anticoagulant therapy OBJECTIVES This study was design ed to compare two treatment strategies in patients with atrial fibrillation(AF ) :  rhythm-control ( restoration and maintenance of sinus rhythm ) and rate-control ( pharmacologic or invasive rate-control and anticoagulation ) . BACKGROUND Atrial fibrillation is the most common arrhythmia . It is unclear whether a strategy of rhythm- or rate-control is better in terms of mortality , morbidity , and quality of life . METHODS The Strategies of Treatment of Atrial Fibrillation ( STAF ) multicenter pilot trial r and omized 200 patients ( 100 per group ) with persistent AF to rhythm- or rate-control .  The combined primary end point was a combination of death , cardiopulmonary resuscitation , cerebrovascular event , and systemic embolism . RESULTS After 19.6 + /- 8.9 months ( range 0 to 36 months ) there was no difference in the primary end point between rhythm-control ( 9/100 ; 5.54%/year ) and rate-control ( 10/100 ; 6.09%/year ; p = 0.99 ) . The percentage of patients in sinus rhythm in the rhythm-control group after up to four cardioversions during the follow-up period ( rate-control group ) was 23 % ( 0 % ) at 36 months . Eighteen primary end points occurred in atrial fibrillation ; only one occurred in sinus rhythm ( p = 0.049 ) . CONCLUSIONS The STAF pilot study showed no differences between the two treatment strategies in all end points except hospitalizations . These data suggest that there was no benefit in attempting rhythm-control in these patients with a high risk of arrhythmia recurrence . It remains unclear whether the results in the rhythm-control group would have been better if sinus rhythm had been maintained in a higher proportion of patients , as all but one end point occurred during AF AIMS Women have an increased risk for atrial fibrillation (AF)-related complications and there is evidence towards a reduced efficacy of the rhythm control strategy than men . A catheter-based strategy is therefore widely attractive , but the impact of gender on catheter ablation ( CA ) of AF remains undefined . METHODS AND RESULTS We included 221 consecutive patients ( 150 men ) who underwent CA of drug-refractory AF .  Gender differences in clinical presentation and outcomes were compared . Women were older ( P = 0.002 ) , had a longer history of AF ( P = 0.04 ) , and were more likely to have hypertension ( P = 0.04 ) . Moreover , a concomitant valvular heart disease tended to be more common in women ( 32.4 vs. 23.3 % ; P = 0.28 ) and left atrium dimensions were significantly larger ( P = 0.003 ) . However , acute success rate and complications rate were similar between genders . After 22.5 + /- 11.8 months of follow-up , the overall freedom from arrhythmia recurrences was similar ( 83.1 vs. 82.7 % in men ) , and a similar improvement in SF-36 quality of life scores was achieved in both groups . CONCLUSION Women are referred for AF ablation later with a more complex clinical pre-operative presentation . Despite this higher risk profile in women , no differences were detected in clinical outcomes . Our findings indicate that CA of AF appears to be safe and effective in women as in men BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia that frequently recurs after restoration of sinus rhythm ( SR ) . Identifying risk factors for recurrence may help define the best strategy for secondary prevention . METHODS The GISSI-AF trial enrolled 1,442 patients in SR with at least 2 documented AF episodes in the previous 6 months or after cardioversion in the last 2 weeks . Patients were r and omized to valsartan or placebo ; all other treatments for AF or underlying heart diseases were allowed . Primary end points were time to first recurrence of AF and proportion of patients with > 1 AF episode during 1-year follow-up . We evaluated  clinical and electrocardiographic baseline characteristics  of all patients to identify independent predictors for AF recurrence using a Cox multivariable model . RESULTS Risk factors for AF recurrence were a history of 2 or more AF episodes in the previous 6 months , independent of the modality of SR restoration , spontaneous ( HR 1.42 , 95 % CI 1.14 - 1.77 , P = .002 ) , or by cardioversion ( HR 1.19 , 95 % CI 1.01 - 1.40 , P = .038 ) , and a lower heart rate during SR ( HR 0.99 , 95 % CI 0.99 - 1.00 , P = .052 ) . The risk factors were the same for > 1 AF recurrence . Patients treated with amiodarone had a lower risk for both end points ( P < .0001 and P = .017 ) , whereas those on diuretics had a greater risk ( P = .009 and P = .003 ) . CONCLUSIONS In the GISSI-AF study population , AF history had significant prognostic value independent of the modality of SR restoration . Amiodarone and diuretic treatment affected the rate of AF recurrence INTRODUCTION  Persistent atrial fibrillation ( persAF ) can occur either as a sustained arrhythmia that has progressed from initially paroxysmal AF or as primary persAF without a history of any spontaneously terminated episode . There is a paucity of data differentiating between the 2 different persAF entities . Thus , we prospect ively evaluated baseline characteristics , electrophysiological features , and ablation outcome in these 2 patient cohorts . METHODS AND RESULTS A total number of 154 consecutive persAF patients ( 63 ± 10 years , f = 42 , longst and ing persAF = 60 ) were characterized in terms of having  primary persAF ( P-persAF group ) or persAF that secondarily progressed from paroxysmal AF ( S-persAF group ) . All patients underwent de novo catheter ablation using the stepwise approach . PersAF entities were characterized by detailed patient history , sequential Holter monitoring , and reports of documented modes of AF conversion , respectively . The P-persAF group had a higher number of  young patients ( < 50 years ) , a shorter AF history , and a higher number of congestive heart failure . The HATCH score did not differ between the groups . Procedural AF termination rate was significantly higher in S-persAF than in P-persAF patients ( n = 55 [ 81 % ] vs. n = 58 [ 68 % ] , P = 0.043 ) . At 1-year follow-up , the arrhythmia-free survival after a single procedure was significantly lower in patients with P-persAF ( 26 % vs. 43 % , P = 0.016 ) . Categorization to P-persAF was the strongest independent predictor of arrhythmia recurrence . CONCLUSIONS P-persAF seems to be a specific arrhythmia entity that is associated with a lower AF-termination rate and a worse outcome after catheter ablation as compared to S-persAF AIMS Early recurrences of atrial arrhythmia after wide electrically isolating ablation for atrial fibrillation ( AF ) are well described , but the long-term risk of recurrence for patients with persistent and permanent AF has not been studied in detail . METHODS AND RESULTS Fifty-six consecutive patients [ 45 men ( 80.4 % ) , age 55.9 + /- 8.7 years ] with persistent [ 39(69.6 % ) ] or permanent [ 17(30.4 % ) ] AF were followed for 21.6 + /- 8.8 months after ablation . Atrial fibrillation duration prior to ablation was 6.4 + /- 5.6 years .  Electrically isolating lesions encircling the left and right pulmonary veins ( PVs ) in pairs were created . After 1.5 + /- 0.7 procedures , 48 ( 85.7 % ) had sinus rhythm ( SR ) at 21.6 + /- 8.8 months of follow-up : achieved with 1 procedure in 27 ( 56.3 % ) and without anti-arrhythmics in 30 ( 62.5 % ) . Atrial fibrillation recurrence was observed in 69.6 % after the first and 46.4 % after the last procedure . Of those with late recurrences ( > 90 days ) following the last procedure , most [ 18 ( 69.2 % ) ] did not have early recurrences . Pre-procedural AF duration ( P = 0.007 ) and female gender ( P = 0.005 ) were independent predictors of recurrence following the last procedure . CONCLUSION Circumferential PV isolation is effective in most patients with persistent or permanent AF . However , repeat procedures are frequently required . Late recurrences are common and not precluded by the absence of early post-procedural arrhythmias OBJECTIVES To evaluate supplementary cavotricuspid isthmus ( CTI ) ablation as an adjunct to  atrial fibrillation ( AF ) ablation in selected patients . BACKGROUND It is unclear whether routine CTI ablation is beneficial in all patients undergoing AF ablation . METHODS AND RESULTS In patients undergoing AF ablation , additional CTI block was created only for those with typical atrial flutter ( Afl ) before or during the ablation . Out of 188 consecutive patients ( 108 male , 56 + /- 9 years ) , 75 underwent CTI ablation ( Group CTI+ ) and left atrial ( LA ) ablation ( circular mapping-guided extensive pulmonary vein isolation in all and linear LA ablation when required ) , while 113 underwent LA ablation alone ( Group CTI- ) . Group CTI+ patients had smaller LA and less frequently persistent/permanent AF and linear LA ablation . Over a follow-up of 30 + /- 10 months , complications ( 4 % vs 5 % , P = NS ) , typical Afl occurrence ( 1.3 % and 2.6 % , P = NS ) and AF recurrence ( 25 % and 28 % , P = NS ) were similar . Atypical Afl was more common in Group CTI- ( 4 vs 14 % , P = 0.026 ) . Eighty-two percent and 79 % of patients in Groups CTI+ and CTI- , respectively , remained arrhythmia free in stable sinus rhythm without antiarrhythmic drug treatment ( P = NS ) . CONCLUSIONS Avoiding supplementary CTI ablation in AF ablation patients without evidence of typical flutter does not result in a higher incidence of typical Afl . Despite more persistent/permanent AF and larger LA in patients without evidence of typical flutter , a strategy of selective supplementary ablation result ed in similar and low AF recurrence rates in the group without CTI ablation compared with the group with CTI ablation AIMS Digoxin is recommended for long-term rate control in paroxysmal , persistent , and permanent atrial fibrillation ( AF ) . While some analyses suggest an association of digoxin with a higher mortality in AF , the intrinsic nature of this association has not been examined in propensity-matched cohorts , which is the objective of the current study . METHODS AND RESULTS In Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) , 4060 patients with paroxysmal and persistent AF were r and omized to rate ( n = 2027 ) vs. rhythm ( n = 2033 ) control strategies . Of these , 1377 received digoxin as initial therapy and 1329 received no digoxin at baseline . Propensity scores for digoxin use were estimated for each of these 2706 patients and used to assemble a cohort of 878 pairs of patients receiving and not receiving digoxin , who were balanced on 59 baseline characteristics . Matched patients had a mean age of 70 years , 40 % were women , and 11 % non-white . During the 3.4 years of the mean follow-up , all-cause mortality occurred in 14 and 13 % of matched patients receiving and not receiving digoxin , respectively [ hazard ratio ( HR ) associated with digoxin use : 1.06 ; 95 % confidence interval ( CI ) : 0.83 - 1.37 ; P = 0.640 ] . Among matched patients , digoxin had no association with all-cause hospitalization ( HR : 0.96 ; 95 % CI : 0.85 - 1.09 ; P = 0.510 ) or incident non-fatal cardiac arrhythmias ( HR : 0.90 ; 95 % CI : 0.37 - 2.23 ; P = 0.827 ) . Digoxin had no multivariable-adjusted or propensity score-adjusted associations with these outcomes in the pre-match cohort . CONCLUSIONS In patients with paroxysmal and persistent AF , we found no evidence of increased mortality or hospitalization in those taking digoxin as baseline initial therapy OBJECTIVES This study sought to determine whether ablation of complex fractionated atrial electrograms ( CFAEs ) after antral pulmonary vein isolation ( APVI ) further improves the clinical outcome of APVI in patients with long-lasting persistent atrial fibrillation ( AF ) . BACKGROUND Ablation of CFAEs has been reported to eliminate persistent AF . However , residual pulmonary vein arrhythmogenicity is a common mechanism of recurrence . METHODS In this r and omized study , 119 consecutive patients ( mean age 60 + /- 9 years ) with long-lasting persistent AF underwent APVI with an irrigated-tip radiofrequency ablation catheter . Antral pulmonary vein isolation result ed in termination of AF in 19 of 119 patients ( Group A , 16 % ) . The remaining 100 patients who still were in AF were r and omized to no further ablation and underwent cardioversion ( Group B , n = 50 ) or to ablation of CFAEs in the left atrium or coronary sinus for up to 2 additional hours of procedure duration ( Group C , n = 50 ) . RESULTS Atrial fibrillation terminated during ablation of CFAEs in 9 of 50 patients ( 18 % ) in Group C. At 10 + /- 3 months after a single ablation procedure , 18 of 50 ( 36 % ) in Group B and 17 of 50 ( 34 % ) in Group C were in sinus rhythm without antiarrhythmic drugs ( p = 0.84 ) . In Group A , 15 of 19 patients ( 79 % ) were in sinus rhythm . A repeat ablation procedure was performed in 34 of 100 r and omized patients ( for AF in 30 and atrial flutter in 4 ) . At 9 + /- 4 months after the final procedure , 34 of 50 ( 68 % ) in Group B and 30 of 50 ( 60 % ) in Group C were in sinus rhythm without antiarrhythmic drugs ( p = 0.40 ) . CONCLUSIONS Up to 2 h of additional ablation of CFAEs after APVI does not appear to improve clinical outcomes in patients with long-lasting persistent AF Chronic atrial fibrillation ( AF ) is a common arrhythmia with significant morbidity and mortality . AF has been the subject of considerable attention and intensive clinical research in recent years . Current opinion on the management of AF favors the restoration and maintenance of normal ventricular rhythm . This has several potential benefits , including the alleviation of arrhythmia-associated symptoms and hemodynamic improvements . Maintenance of frequents normalization of ventricular rhythm ( NVR ) can be achieved with antiarrhythmic drug therapy or with AV node radiofrequency ablation ( RFA ) and permanent ventricular pacing . Recent interest has focused on the use of class III antiarrhythmic agents , such as amiodarone hydrochloride . This investigation compared amiodarone to AV node RFA and permanent pacing of the His-bundle area in maintaining NVR in patients with resistant chronic AF . After 12 months of treatment with amiodarone ( 200 to 400 mg/d ) 30 % of patients remained in NVR , 30 % were in transitional phase of improvement , and 40 % showed negative effect . Only a few patients in this group developed ocular or hepatic side effects . On one year follow-up was achieved in 100 % of cases without any clinical ly significant side effects being seen . In conclusion , analysis of the results of this study suggests that low-dose amiodarone is well tolerated in the management of chronic AF in a selected patient population . The more aggressive interventional radiofrequency ablation technique is significantly more effective and more reliable in the long-term clinical treatment of drug-resistant AF
This review article provides an overview on the published clinical risk scores related to outcomes of rhythm control strategy or AF progression
Patients with atrial fibrillation ( AF ) are commonly managed with rhythm control strategy , but the natural history of this common arrhythmia leads itself to progression from paroxysmal to persistent or permanent AF , and recurrences are evident despite rhythm control treatments using cardioversion or catheter ablation .
Numerous clinical factors have been associated with outcomes of rhythm control or arrhythmia progression in patients with AF .
The more common factors have been used to formulate risk stratification scores , to help predict the outcomes of rhythm control treatments  or AF progression .