{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T15:25:39Z","timestamp":1767626739919,"version":"3.37.3"},"reference-count":27,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2017,6,30]],"date-time":"2017-06-30T00:00:00Z","timestamp":1498780800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100004374","name":"Medtronic","doi-asserted-by":"publisher","award":["ERP 3563"],"award-info":[{"award-number":["ERP 3563"]}],"id":[{"id":"10.13039\/100004374","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"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We investigated the rates and reasons for crossover to alternative treatment strategies and its impact on mortality in patients who were enrolled in the Atrial Fibrillation Follow\u2010up Investigation of Rhythm Management (AFFIRM) trial. Over a mean follow\u2010up period of 3.5 years, 842 patients underwent crossover to the alternative treatment arms in AFFIRM. The rate of crossover from rhythm to rate control (594\/2,033, 29.2%) was more frequent than the rate of crossover from rate to rhythm control (248\/2,027, 12.2%, P &lt; 0.0001). The leading reasons for crossover from rhythm to rate control were failure to achieve or maintain sinus rhythm (272\/594, 45.8%) and intolerable adverse effects (122\/594, 20.5%). In comparison, the major reasons for crossover from rate to rhythm control were failure to control atrial fibrillation symptoms (159\/248, 64.1%) and intolerable adverse effects (9\/248, 3.6%). This difference in crossover pattern was statistically significant (P &lt; 0.0001). There was a significantly decreased risk of all\u2010cause mortality (adjusted HR: 0.61, 95% CI: 0.48\u20130.78, P &lt; 0.0001) and cardiac mortality (adjusted hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.43\u20130.88, P = 0.008) in the subgroup of patients who crossed over from rhythm to rate control as compared to those who continued in rhythm control. There was a nonsignificant trend toward decreased all\u2010cause (adjusted HR: 0.76, 95% CI: 0.53\u20131.10, P = 0.14) and cardiac mortality (adjusted HR: 0.70, 95% CI: 0.42\u20131.18, P = 0.18) in patients who crossed over from rate to rhythm control as compared to those who continued rate control.<\/jats:p>","DOI":"10.1111\/pace.13112","type":"journal-article","created":{"date-parts":[[2017,5,25]],"date-time":"2017-05-25T16:37:40Z","timestamp":1495730260000},"page":"770-778","source":"Crossref","is-referenced-by-count":3,"title":["Impact of treatment crossovers on clinical outcomes in the rate and rhythm control strategies for atrial fibrillation: Insights from the AFFIRM (Atrial Fibrillation Follow\u2010up Investigation of Rhythm Management) trial"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9871-0438","authenticated-orcid":false,"given":"Abhishek","family":"Maan","sequence":"first","affiliation":[{"name":"Division of Cardiology The Warren Alpert School of Brown University  Providence RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Brown University School of Public Health  Providence RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziling","family":"Qin","sequence":"additional","affiliation":[{"name":"Brown University School of Public Health  Providence RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanbing","family":"Wang","sequence":"additional","affiliation":[{"name":"Brown University School of Public Health  Providence RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Dudley","sequence":"additional","affiliation":[{"name":"Division of Cardiology The Warren Alpert School of Brown University  Providence RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaustubh","family":"Dabhadakar","sequence":"additional","affiliation":[{"name":"Division of Cardiology The Warren Alpert School of Brown University  Providence RI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marwan","family":"Refaat","sequence":"additional","affiliation":[{"name":"American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moussa","family":"Mansour","sequence":"additional","affiliation":[{"name":"Cardiac Arrhythmia Service and Heart Center Massachusetts General Hospital  Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy N.","family":"Ruskin","sequence":"additional","affiliation":[{"name":"Cardiac Arrhythmia Service and Heart Center Massachusetts General Hospital  Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. Kevin","family":"Heist","sequence":"additional","affiliation":[{"name":"Cardiac Arrhythmia Service and Heart Center Massachusetts General Hospital  Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,6,30]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.22.8.983"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2002.008748"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2002.122518"},{"key":"e_1_2_6_5_1","first-page":"997","article-title":"Comparative effectiveness of rhythm control versus rate control drug treatment effect on mortality in patients with atrial fibrillation","volume":"172","author":"Ionscu\u2010Ittu R","year":"2012","journal-title":"Arch Intern Med."},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.092494"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-300550"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.110.957563"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021328"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021375"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(97)00082-9"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.104.3.292"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041705"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.03.022"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-300550"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.12.019"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.21.2634"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht457"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa050955"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0803778"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.114.001499"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.01.066"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0157433"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(92)90453-T"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euw126"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0800456"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199103213241201"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.114.002046"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpace.13112","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.13112","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T16:28:43Z","timestamp":1696264123000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.13112"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6,30]]},"references-count":27,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2017,7]]}},"alternative-id":["10.1111\/pace.13112"],"URL":"https:\/\/doi.org\/10.1111\/pace.13112","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"type":"print","value":"0147-8389"},{"type":"electronic","value":"1540-8159"}],"subject":[],"published":{"date-parts":[[2017,6,30]]}}}