{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:19:33Z","timestamp":1787509173717,"version":"build-2736575974"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,4,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Rhythm control with class 1C antiarrhythmic drugs (AADs) is a widely used treatment among patients with atrial fibrillation (AF), but cardiovascular benefits of class 1C pharmacotherapy over rate control strategy are still unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Adult patients with AF (n=100\u2009748; 45% women) evaluated at a multihospital health system between 2010 and 2023 were assessed on clinical characteristics and class 1C AAD use and long\u2010term outcomes ascertained. Covariate balance across 36 factors was achieved using propensity score matching. Adjusted Cox modeling with competing risk analysis was used to compare patients using rhythm control (class 1C) with those offered a rate control strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Patients receiving a class 1C AAD (n=5239 [5%]) (70% flecainide) were significantly younger with lower cardiovascular risk factors (hypertension, diabetes, coronary artery disease, heart failure) and less comorbidity burden. Over a mean follow\u2010up of 5\u00b13\u2009years, matched patients receiving a class 1C AAD had significantly less all\u2010cause death (14% versus 19%; hazard ratio [HR], 0.65 [95% CI, 0.57\u20130.74];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). Age (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.017), CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc score (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.0003), and comorbidity burden (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.032) modify this relationship, while prior revascularization (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.83) or presence of coronary artery disease had no significant (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.54) impact. Class 1C recipients also had lower stroke hospitalization (3.6% versus 4.8%; HR, 0.82 [95% CI, 0.8\u20130.95];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.01), while those aged 65 to 80\u2009years experienced less heart failure (HR, 0.84 [95% CI, 0.71\u20130.98];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.03) and major bleeding (HR, 0.8 [95% CI, 0.65\u20130.98];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.039) as well.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In a real\u2010world contemporary registry of patients with AF from a North American health care system, use of class 1C AADs for rhythm control was associated with improved survival and hospitalization for stroke compared with rate control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.044986","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T09:47:02Z","timestamp":1775728022000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Long\u2010Term Outcomes With Class 1C Antiarrhythmic Drug Use in Atrial Fibrillation"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7827-5977","authenticated-orcid":false,"given":"Aditya","family":"Bhonsale","sequence":"first","affiliation":[{"name":"University of Pittsburgh Medical Center","place":["Pittsburgh, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1306-4444","authenticated-orcid":false,"given":"Yisi","family":"Wang","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, UPMC","place":["Pittsburgh, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floyd","family":"Thoma","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, UPMC","place":["Pittsburgh, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2550-9359","authenticated-orcid":false,"given":"Krishna","family":"Kancharla","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center","place":["Pittsburgh, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1577-6541","authenticated-orcid":false,"given":"Andrew","family":"Voigt","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center","place":["Pittsburgh, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2000-7678","authenticated-orcid":false,"given":"Alaa","family":"Shalaby","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center","place":["Pittsburgh, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0880-405X","authenticated-orcid":false,"given":"Aditi","family":"Naniwadekar","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center","place":["Pittsburgh, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Singla","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center","place":["Pittsburgh, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5461-7247","authenticated-orcid":false,"given":"N. 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