Skip to main content
Journal cover image

Use and outcomes of antiarrhythmic therapy in patients with atrial fibrillation receiving oral anticoagulation: results from the ROCKET AF trial.

Publication ,  Journal Article
Steinberg, BA; Hellkamp, AS; Lokhnygina, Y; Halperin, JL; Breithardt, G; Passman, R; Hankey, GJ; Patel, MR; Becker, RC; Singer, DE; Hacke, W ...
Published in: Heart Rhythm
June 2014

BACKGROUND: Antiarrhythmic drugs (AADs) and anticoagulation are mainstays of atrial fibrillation (AF) treatment. OBJECTIVE: To study the use and outcomes of AAD therapy in anticoagulated patients with AF. METHODS: Patients in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation trial (N = 14,264) were stratified by AAD use at baseline: amiodarone, other AAD, or no AAD. Multivariable adjustment was performed to compare stroke, bleeding, and death across AAD groups as well as across treatment assignment (rivaroxaban or warfarin). RESULTS: Of 14,264 patients randomized, 1681 (11.8%) were treated with an AAD (1144 [8%] with amiodarone and 537 [3.8%] with other AADs). Amiodarone-treated patients were less often female (38% vs 48%), had more persistent AF (64% vs 40%), and more concomitant heart failure (71% vs 41%) than were patients receiving other AADs. Patients receiving no AAD more closely resembled amiodarone-treated patients. Time in therapeutic range was significantly lower in warfarin-treated patients receiving amiodarone than in those receiving no AAD (50% vs 58%; P < .0001). Compared with no AAD, neither amiodarone (adjusted hazard ratio [HR] 0.98; 95% confidence interval [CI] 0.74-1.31; P = .9) nor other AADs (adjusted HR 0.66; 95% CI 0.37-1.17; P = .15) were associated with increased mortality. Similar results were observed for embolic and bleeding outcomes. Treatment effects of rivaroxaban vs warfarin in patients receiving no AAD were consistent with results from the overall trial (primary end point: adjusted HR 0.82; 95% CI 0.68-0.98; Pinteraction = .06; safety end point: adjusted HR 1.12; 95% CI 0.90-1.24; Pinteraction = .33). CONCLUSION: Treatment with AADs was not associated with increased morbidity or mortality in anticoagulated patients with AF. The effect of amiodarone on outcomes in patients receiving rivaroxaban requires further investigation.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Heart Rhythm

DOI

EISSN

1556-3871

Publication Date

June 2014

Volume

11

Issue

6

Start / End Page

925 / 932

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Thiophenes
  • Rivaroxaban
  • Morpholines
  • Middle Aged
  • Male
  • Intention to Treat Analysis
  • Humans
  • Female
  • Cardiovascular System & Hematology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Steinberg, B. A., Hellkamp, A. S., Lokhnygina, Y., Halperin, J. L., Breithardt, G., Passman, R., … ROCKET AF Steering Committee and Investigators, . (2014). Use and outcomes of antiarrhythmic therapy in patients with atrial fibrillation receiving oral anticoagulation: results from the ROCKET AF trial. Heart Rhythm, 11(6), 925–932. https://doi.org/10.1016/j.hrthm.2014.03.006
Steinberg, Benjamin A., Anne S. Hellkamp, Yuliya Lokhnygina, Jonathan L. Halperin, Günter Breithardt, Rod Passman, Graeme J. Hankey, et al. “Use and outcomes of antiarrhythmic therapy in patients with atrial fibrillation receiving oral anticoagulation: results from the ROCKET AF trial.Heart Rhythm 11, no. 6 (June 2014): 925–32. https://doi.org/10.1016/j.hrthm.2014.03.006.
Steinberg BA, Hellkamp AS, Lokhnygina Y, Halperin JL, Breithardt G, Passman R, et al. Use and outcomes of antiarrhythmic therapy in patients with atrial fibrillation receiving oral anticoagulation: results from the ROCKET AF trial. Heart Rhythm. 2014 Jun;11(6):925–32.
Steinberg, Benjamin A., et al. “Use and outcomes of antiarrhythmic therapy in patients with atrial fibrillation receiving oral anticoagulation: results from the ROCKET AF trial.Heart Rhythm, vol. 11, no. 6, June 2014, pp. 925–32. Pubmed, doi:10.1016/j.hrthm.2014.03.006.
Steinberg BA, Hellkamp AS, Lokhnygina Y, Halperin JL, Breithardt G, Passman R, Hankey GJ, Patel MR, Becker RC, Singer DE, Hacke W, Berkowitz SD, Nessel CC, Mahaffey KW, Fox KAA, Califf RM, Piccini JP, ROCKET AF Steering Committee and Investigators. Use and outcomes of antiarrhythmic therapy in patients with atrial fibrillation receiving oral anticoagulation: results from the ROCKET AF trial. Heart Rhythm. 2014 Jun;11(6):925–932.
Journal cover image

Published In

Heart Rhythm

DOI

EISSN

1556-3871

Publication Date

June 2014

Volume

11

Issue

6

Start / End Page

925 / 932

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Thiophenes
  • Rivaroxaban
  • Morpholines
  • Middle Aged
  • Male
  • Intention to Treat Analysis
  • Humans
  • Female
  • Cardiovascular System & Hematology