{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:46:58Z","timestamp":1791809218813,"version":"4.3.4"},"reference-count":52,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T00:00:00Z","timestamp":1720051200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T00:00:00Z","timestamp":1720051200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rheumatic heart disease with persistent atrial fibrillation (RHD\u2010AF) is associated with increased morbidity. However, there is no standardized approach for the maintenance of sinus rhythm (SR) in them. We aimed to determine the utility of a stepwise approach to achieve SR in RHD\u2010AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive patients with RHD\u2010AF from July 2021 to August 2023 formed the study cohort. The stepwise approach included pharmacological rhythm control and\/or electrical cardioversion (Central illustration). In patients with recurrence, additional options included AF ablation or pace and ablate strategy with conduction system pacing or biventricular pacing. Clinical improvement, NT\u2010proBNP, 6\u2010Minute Walk Test (6MWT), heart failure (HF) hospitalizations, and thromboembolic complications were documented during follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty\u2010three patients with RHD\u2010AF (mean age 56.13\u00a0\u00b1\u00a09.51 years, women 72.28%) were included. Utilizing this approach, 43 (51.81%) achieved and maintained SR during the study period of 11.04\u00a0\u00b1\u00a07.14 months. These patients had improved functional class, lower NT\u2010proBNP, better distance covered for 6MWT, and reduced HF hospitalizations. The duration of AF was shorter in patients who achieved SR, compared to those who remained in AF (3.15\u00a0\u00b1\u00a01.29\u00a0vs 6.93\u00a0\u00b1\u00a05.23,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.041). Thirty\u2010five percent (29) maintained SR after a single cardioversion over the study period. Only one underwent AF ablation. Of the 24 who underwent pace and ablate strategy, atrial lead was implanted in 22 (hybrid approach), and 50% of these achieved and maintained SR. Among these 24, none had HF hospitalizations, but patients who maintained SR had further improvement in clinical and functional parameters.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>RHD\u2010AF patients who could achieve SR with a stepwise approach, had better clinical outcomes and lower HF hospitalizations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.15041","type":"journal-article","created":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T12:09:49Z","timestamp":1720094989000},"page":"1096-1107","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcome of tailored therapy in rheumatic heart disease with persistent atrial fibrillation (RHD\u2010AF)"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4508-8814","authenticated-orcid":false,"given":"Daljeet Kaur","family":"Saggu","sequence":"first","affiliation":[{"name":"Department of Cardiology AIG Hospital  Hyderabad India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7757-2785","authenticated-orcid":false,"given":"Muthiah","family":"Subramaniam","sequence":"additional","affiliation":[{"name":"Department of Cardiology AIG Hospital  Hyderabad India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radhika","family":"Korabathina","sequence":"additional","affiliation":[{"name":"Department of Cardiology AIG Hospital  Hyderabad India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. Soma","family":"Raju","sequence":"additional","affiliation":[{"name":"Department of Cardiology AIG Hospital  Hyderabad India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Auras R.","family":"Atreya","sequence":"additional","affiliation":[{"name":"Department of Cardiology AIG Hospital  Hyderabad India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasad","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Cardiology AIG Hospital  Hyderabad India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. 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