{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:42:13Z","timestamp":1789663333996,"version":"4.0.1"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2021,4,26]],"date-time":"2021-04-26T00:00:00Z","timestamp":1619395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Netherlands Heart Foundation","award":["2008B035"],"award-info":[{"award-number":["2008B035"]}]},{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004326","name":"Bayer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004326","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005035","name":"Biotronik","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005035","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Boehringer-Ingelheim"},{"DOI":"10.13039\/100008497","name":"Boston Scientific","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004374","name":"Medtronic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004374","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004339","name":"Sanofi-Aventis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004339","id-type":"DOI","asserted-by":"publisher"}]},{"name":"St Jude Medical paid to the Netherlands Heart Institute"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Maintaining sinus rhythm in patients with persistent atrial fibrillation (AF) is challenging. We explored the efficacy of class I and III antiarrhythmic drugs (AADs) in patients with persistent AF and mild to moderate heart failure (HF).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>In the RACE 3 trial, patients with early persistent symptomatic AF and short history of mild to moderate HF with preserved or reduced left ventricular ejection fraction (LVEF) were randomized to targeted or conventional therapy. Both groups received AF and HF guideline-driven treatment. Additionally, the targeted-group received mineralocorticoid receptor antagonists, statins, angiotensin-converting enzyme inhibitors and\/or receptor blockers, and cardiac rehabilitation. Class I and III AADs could be instituted in case of symptomatic recurrent AF. Eventually, pulmonary vein isolation could be performed. Primary endpoint was sinus rhythm on 7-day Holter after 1-year. Included were 245 patients, age 65\u2009\u00b1\u20099\u2009years, 193 (79%) men, AF history was 3 (2\u20136) months, HF history 2 (1\u20134) months, 72 (29.4%) had HF with reduced LVEF. After baseline electrical cardioversion (ECV), 190 (77.6%) had AF recurrences; 108 (56.8%) received class I\/III AADs; 19 (17.6%) flecainide, 36 (33.3%) sotalol, 3 (2.8%) dronedarone, 50 (46.3%) amiodarone. At 1-year 73 of 108 (68.0%) patients were in sinus rhythm, 44 (40.7%) without new AF recurrences. Maintenance of sinus rhythm was significantly better with amiodarone [n\u2009=\u200929\/50 (58%)] compared with flecainide [n\u2009=\u20096\/19 (32%)] and sotalol\/dronedarone [n\u2009=\u20099\/39 (23%)], P\u2009=\u20090.0064. Adverse events occurred in 27 (25.0%) patients, were all minor and reversible.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In stable HF patients with early persistent AF, AAD treatment was effective in nearly half of patients, with no serious adverse effects reported.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euab062","type":"journal-article","created":{"date-parts":[[2021,3,3]],"date-time":"2021-03-03T12:18:02Z","timestamp":1614773882000},"page":"1359-1368","source":"Crossref","is-referenced-by-count":20,"title":["Antiarrhythmic drugs in patients with early persistent atrial fibrillation and heart failure: results of the RACE 3 study"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6042-3115","authenticated-orcid":false,"given":"Meelad I H","family":"Al-Jazairi","sequence":"first","affiliation":[{"name":"Department of Cardiology, University of Groningen, Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao-Oanh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben R","family":"De With","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelle D","family":"Smit","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Martini Hospital, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bob","family":"Weijs","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne H","family":"Hobbelt","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Alings","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amphia Hospital Breda, Julius Clinical Zeist, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan G P","family":"Tijssen","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastiaan","family":"Geelhoed","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans L","family":"Hillege","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G","family":"Tieleman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Martini Hospital, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk J","family":"Van Veldhuisen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry J G M","family":"Crijns","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle C","family":"Van Gelder","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuri","family":"Blaauw","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2581-070X","authenticated-orcid":false,"given":"Michiel","family":"Rienstra","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the RACE 3 Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,4,26]]},"reference":[{"key":"2021090908323313800_euab062-B1","doi-asserted-by":"crossref","first-page":"2516","DOI":"10.1161\/CIRCULATIONAHA.108.821306","article-title":"Atrial fibrillation and heart failure: treatment considerations for a dual epidemic","volume":"119","author":"Anter","year":"2009","journal-title":"Circulation"},{"key":"2021090908323313800_euab062-B2","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1056\/NEJMoa1707855","article-title":"Catheter ablation for atrial fibrillation with heart failure","volume":"378","author":"Marrouche","year":"2018","journal-title":"N Engl J Med"},{"key":"2021090908323313800_euab062-B3","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Hindricks","journal-title":"Eur Heart J"},{"key":"2021090908323313800_euab062-B4","doi-asserted-by":"crossref","first-page":"2987","DOI":"10.1093\/eurheartj\/ehx739","article-title":"Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation: results of the RACE 3 trial","volume":"39","author":"Rienstra","year":"2018","journal-title":"Eur Heart J"},{"key":"2021090908323313800_euab062-B5","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/europace\/euy311","article-title":"Targeted therapy of underlying conditions improves quality of life in patients with persistent atrial fibrillation: results of the RACE 3 study","volume":"21","author":"De With","year":"2019","journal-title":"Europace"},{"key":"2021090908323313800_euab062-B6","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.ahj.2019.12.005","article-title":"Optimal treatment of underlying conditions improves rhythm control outcome in atrial fibrillation \u2013 Data from RACE 3","volume":"226","author":"Nguyen","year":"2020","journal-title":"American Heart Journal"},{"key":"2021090908323313800_euab062-B7","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1007\/s12471-013-0428-5","article-title":"Routine versus aggressive upstream rhythm control for prevention of early atrial fibrillation in heart failure: background, aims and design of the RACE 3 study","volume":"21","author":"Alings","year":"2013","journal-title":"Neth Heart J"},{"key":"2021090908323313800_euab062-B8","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur Heart J"},{"key":"2021090908323313800_euab062-B9","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1093\/eurheartj\/ehi637","article-title":"Mending the rhythm does not improve prognosis in patients with persistent atrial fibrillation: a subanalysis of the RACE study","volume":"27","author":"Rienstra","year":"2006","journal-title":"Eur Heart J"},{"key":"2021090908323313800_euab062-B10","doi-asserted-by":"crossref","first-page":"2585","DOI":"10.1001\/archinte.1996.00440210109011","article-title":"Chronic atrial fibrillation. Success of serial cardioversion therapy and safety of oral anticoagulation","volume":"156","author":"Van Gelder","year":"1996","journal-title":"Arch Intern Med"},{"key":"2021090908323313800_euab062-B11","first-page":"CD005049","article-title":"Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation","volume":"28","author":"Lafuente-Lafuente","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"2021090908323313800_euab062-B12","first-page":"CD005049","article-title":"Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation","volume":"9","author":"Valembois","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2021090908323313800_euab062-B13","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1111\/jce.12535","article-title":"Efficacy of amiodarone in patients with atrial fibrillation with and without left ventricular dysfunction: a pooled analysis of AFFIRM and AF-CHF trials","volume":"25","author":"Cadrin-Tourigny","year":"2014","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2021090908323313800_euab062-B14","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/S0735-1097(03)00559-X","article-title":"Maintenance of sinus rhythm in patients with atrial fibrillation: an AFFIRM substudy of the first antiarrhythmic drug","volume":"42","year":"2003","journal-title":"J Am Coll Cardiol"},{"key":"2021090908323313800_euab062-B15","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1056\/NEJM200003303421302","article-title":"Amiodarone to prevent recurrence of atrial fibrillation","volume":"342","author":"Roy","year":"2000","journal-title":"N Engl J Med"},{"key":"2021090908323313800_euab062-B16","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.ijcard.2011.06.012","article-title":"Antiarrhythmic drugs for the maintenance of sinus rhythm: risks and benefits","volume":"155","author":"Camm","year":"2012","journal-title":"Int J Cardiol"},{"key":"2021090908323313800_euab062-B17","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/S0002-9149(01)01806-9","article-title":"Long-term efficacy and safety of propafenone and sotalol for the maintenance of sinus rhythm after conversion of recurrent symptomatic atrial fibrillation","volume":"88","author":"Bellandi","year":"2001","journal-title":"Am J Cardiol"},{"key":"2021090908323313800_euab062-B18","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1056\/NEJMoa041705","article-title":"Amiodarone versus sotalol for atrial fibrillation","volume":"352","author":"Singh","year":"2005","journal-title":"N Engl J Med"},{"key":"2021090908323313800_euab062-B19","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1001\/jama.300.15.1784","article-title":"Continuous vs episodic prophylactic treatment with amiodarone for the prevention of atrial fibrillation: a randomized trial","volume":"300","author":"Ahmed","year":"2008","journal-title":"JAMA"},{"key":"2021090908323313800_euab062-B20","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/S0140-6736(12)60570-4","article-title":"Short-term versus long-term antiarrhythmic drug treatment after cardioversion of atrial fibrillation (Flec-SL): a prospective, randomised, open-label, blinded endpoint assessment trial","volume":"380","author":"Kirchhof","year":"2012","journal-title":"Lancet"}],"container-title":["EP Europace"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/europace\/article-pdf\/23\/9\/1359\/40330339\/euab062.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/europace\/article-pdf\/23\/9\/1359\/40330339\/euab062.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T08:34:12Z","timestamp":1631176452000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/article\/23\/9\/1359\/6252976"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,26]]},"references-count":20,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,4,26]]},"published-print":{"date-parts":[[2021,9,8]]}},"URL":"https:\/\/doi.org\/10.1093\/europace\/euab062","relation":{},"ISSN":["1099-5129","1532-2092"],"issn-type":[{"value":"1099-5129","type":"print"},{"value":"1532-2092","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,9,1]]},"published":{"date-parts":[[2021,4,26]]}}}